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Person-Centred Therapy with Children and Young People

‘The narrative approach draws on the author’s own experiences and will appeal to
practitioners and students in a range of settings where effective child-centred engagement
and communication with children are key.’
Dr Billie Oliver, Associate Professor of Integrated Children & Young People’s Services,
University of the West of England (Bristol) Person-Centred Therapy with

Children and
This engaging new book presents a ‘child-centred’ model of therapy that is thoroughly
person-centred in its values. Reinforcing the roots of child-centred therapy in both child
development theories and Carl Rogers’ model, David Smyth demonstrates that counselling
the person-centred way can be particularly relevant to children and young people (up to 18

Young People
years of age).

Applying this approach to real-life practice in diverse settings, David explores the particular
requirements and challenges to be encountered when working with this age group.The
book covers:

• Person-centred approach and other related theories


• The nature of the practitioner–client relationship
• Developing a child-centred practice



Establishing effective communications with parents and others
Legal and ethical considerations affecting children and young people
Multi-professional practice and education settings.
David Smyth
Written in a warm and accessible style, this book is essential reading for counselling trainees,
as well as adult-trained therapists, looking to gain an insight into working with children from
a person-centred perspective. It is also relevant to professionals in other fields who work
with children and young people.

David Smyth is a person-centred therapist in private practice.

David Smyth

Cover image © DonSmith / Alamy | Cover design by Wendy Scott

smyth_PCT children_aw.indd 1-3 22/01/2013 13:13


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SAGE Publications Ltd  David Smyth 2013
1 Oliver’s Yard
55 City Road First published 2013
London EC1Y 1SP
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those terms should be sent to the publishers.
SAGE Publications Asia-Pacific Pte Ltd
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#10-04 Samsung Hub
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Library of Congress Control Number: 2012944611

British Library Cataloguing in Publication data

A catalogue record for this book is available from


Editor: Alice Oven the British Library
Assistant editor: Kate Wharton
Production editor: Rachel Burrows
Copyeditor: Sarah Bury
Proofreader: Kate Morris
Indexer: Martin Hargreaves
Marketing manager: Tamara Navaratnam
Cover design: Wendy Scott
Typeset by: C&M Digitals (P) Ltd, Chennai, India
Printed by MPG Books Group, Bodmin, Cornwall

ISBN 978-0-85702-759-7
ISBN 978-0-85702-760-3 (pbk)

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Contents

About the Author vi


Foreword by Michael Behr vii
Acknowledgements ix
Author’s Note x
Introduction xii

Part I – Theory and Practice 1


1  The Person-centred Approach – Children and Young People 3
2  Child-centred Therapy – An Introduction 14
3  Associated Child-related Theories 29
4  The Emerging Child-centred Practitioner 42
5  Child-centred Therapy – Developing Practice I 53
6  Child-centred Therapy – Developing Practice II 64
7  Child-centred Therapy – Children with Particular Needs 82
8  Directive and Non-directive Therapy 101
9  Play, Materials and Dialogue in Therapy 112

Part II – Professional Issues 141


10  Receiving Referrals and Communications 143
11  Boundaries in Child-centred Therapy 154
12  Multi-professional Practice 168
13  Aspects of the Law in Child-centred Therapy 180

Conclusion 196
Bibliography 198
Index 213

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About the Author

David Smyth undertook his professional training as a person-


centred therapist at the University of East Anglia under its
director Professor Brian Thorne. This represented a significant
career change that followed thirty years working in the UK’s
National Health Service and as a bursar at a Cambridge col-
lege. He decided to develop his interest in working with chil-
dren and young people and undertook further training in the
Republic of Ireland over the ensuing five years.
Resident in Suffolk, David established an independent practice that has
steadily grown to become a full time commitment. His varied practice
includes children, young people, adults and couples, undertaking occasional
legal work and providing a psychotherapy service to an independent school.
David is married with two grown up children. Away from his professional
work, he enjoys coastline walks and exploring the woods and heathland in
his locality together with his wife and his English Setter, Hugo.

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Foreword by Michael Behr

This is a book not only about working as but also about becoming a child
and adolescent psychotherapist. In this, it is a unique work. David Smyth
discloses his personal journey into his profession. As the reader, I witness his
journey from being externally driven, feeling and doing what others subtly
convey, towards becoming a therapist who gives himself as a congruent
person into an authentic relationship. I was fascinated to read how his experi-
ential mode of being lends an outstanding quality to the therapeutic processes
he thus facilitates today. I envy his young clients and their parents/caregivers
in how lucky they are to experience a therapist who has gone through so many
of the personal distresses of everyday life which they now face – and who is
so very aware of this. Childhood, adolescence, being adult: how life issues
transfer through development and turn into constructive changes. There is a
saying that the really great psychotherapists are unpretentious and humble
people who are very much conscious of their personal limits. David Smyth’s
work is a great support for this claim, and his book offers a kaleidoscope
view of how clients may feel deeply understood out of such a position, and
distinctively facilitated in their development.
As the book proceeds, it deals further with scholarly and very practical
questions within child and adolescent psychotherapy, and the counselling
of parents/caregivers. In this David Smyth proves to be a thorough reader
and thinker who has taken a wide field of literature into account but also
finds personal solutions to the issues in question. Again, this makes the
book a very practical one: the reader can find valuable consideration of a
huge range of issues that are of basic interest in therapeutic practice. These
include: intake procedure, toys, playing, media, refreshments, motivation
for change, parental divorce and separation, different disorders and problems,
record keeping, supervision, boundaries, confidentiality, parents, legislative
matters, gender, end of therapy, resilience, transference, non-directivity
and many more.

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viii  Foreword

I was especially fascinated with the large number of practical examples


offered; here is a therapist who first and foremost draws into his work what
the young clients are teaching him. These examples let the text shift towards
an even higher level of meaningfulness; they convey how David Smyth
relates personally to his practice and his understanding of its processes. In
addition, questions for reflection are inserted throughout the text. They often
stop the flow of reading in an evocative way and encourage the reader to go
the author’s way: switching into an experiential mode and considering what
previous messages mean for personal thinking and feeling.
David Smyth feels himself rooted within a classical approach of person-
centred work. He revisits the conditions model and offers an interpretation
written from a child-centred perspective that remains true to the core
principles. He conveys scepticism wherever multimodal orientations question
the non-directive paradigm of Rogerian therapy. In this, he advocates the
young people’s non-manipulated growth, a growth that evolves out of a
relationship and an experientially aware therapist, and not out of exercises,
behavioural learning, training or tricky cognitive operations. It is a book
very much about being in a therapy session rather than doing therapy. It
may demystify the apparent complexity which scholarly papers sometimes
convey. Within person-centred sub-orientations, working with children and
adolescents will obtain an equal position and be valued equally to other fields
of person-centred work.
So – do not read this book if you think the being and feeling of the therapist
should be separated from the process of therapy. Do not read it if you think
your own personal history should be left aside when becoming a therapist.
Read it if you may join David Smyth when passionately advocating for a
non-manipulated growth of children, a non-intrusive fostering development
and a sense of being young people that allows them wide space and choices
within a secure attachment. Read it if you yourself would only choose a
therapist who is clearly open and proficient to deeply experiencing him or
herself.
If you are not sure, read it too. The book will help you to decide either way.

Michael Behr
Schwäbisch Gmünd, Germany
March 2012

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Acknowledgements

I would like to acknowledge the many people who have helped me with
this work: Alice Oven at Sage Publishing, who has been the most remark-
able person, providing encouragement when I most needed it and for her
unswerving belief; Kate Wharton and Rachel Burrows at Sage, for their
advice and guidance on many different editorial matters; Michael Behr for
his gentle kindness and support; and my professional supervisor, Louise
Young, a thoughtful, patient and resourceful colleague who has seen in me
things I am yet to see in myself. I am indebted to the Headmaster of Ipswich
School and the Head of Ipswich Preparatory School, together with staff and
pupils, for their support in providing illustrations completed during pupils’
PHSE and Art lessons. Their kindness and encouragement has been greatly
appreciated. Marjoke Henrichs has prepared some wonderful illustra-
tions with amazing enthusiasm and interest. She has responded to my
needs thoughtfully and with considerable patience. Her drawing of the
Madonna statue in Parma Cathedral has been reproduced with the kind
permission of the Marquis Pallavicini.
I want to give special mention to Eileen Prendiville, founder of the
Children’s Therapy Centre in Ireland, a key inspiration in my child psycho-
therapy and play therapy training whose wisdom and experience finds its
place in this book, and Brian Thorne who got me going in person-centred
therapy in the first place. I want to thank all the children and young people
who have allowed me to work with them – they are the stars of this book –
and to the grounding afforded by my family in this venture – including
my dear wife Gail, without whom I would be lost. I am worried I have left
somebody out and I hope they can forgive me: it is not intentional but
rather overwhelming.

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Author’s Note

I recognise that, while the term ‘person-centred’ approach is universally


recognisable, ‘play therapy’ is open to interpretation, depending upon the
reader’s existing knowledge and viewpoint. Until I came to finalise the
manuscript, I had not appreciated that my meaning of the term was any-
thing other than universal. I therefore want to clarify my use of the word
‘play’ as conveyed in this book.
My core practice is philosophically founded upon the conditions of
person-centred therapy. It seems to me that, by past convention, this has
been used to describe a form of therapy rooted in the principles devel-
oped by Carl Rogers as an approach to working with adults. These
principles have not tended to relate to therapeutic work with children
and young people. Axline (1947) wrote about play therapy as a way of
working with children. She was a student then colleague of Rogers who,
according to Cochran et al. was ‘the “mother” of the non-directive or
client-centered approach to play therapy’ (2010: 71). The ensuing
decades have seen a development of play therapy utilising a variety of
therapeutic models. It is evident that some now regard play therapy
almost as an autonomous approach. Moreover, West potentially
adds to the terminology confusion with her book Child-Centred Play
Therapy (1996). In quoting other authors I have therefore diminished
the term play therapy where it appears, to therapy. I hope these authors
will understand.
I want to describe the context within which this book has been written: it
is absolutely about the person-centred approach but for children and young
people. I call this child-centred if only to define its relationship to people up
to 18 years of age. Since, as I explain, play is often the preferred therapeutic
means of communication of children of a certain age group, I now recognise
that to describe this as play therapy could be misleading. This book is not
about the person-centred approach and play therapy – implying two differ-
ent therapeutic approaches. It is, as the title states: Person-Centred Therapy for

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Author’s Note  xi

Children and Young People in which the human individual grows and devel-
ops along a continuum of life experience travelling through childhood to
adulthood.
The case examples described in this book illustrate the concepts and
aspects of my professional practice. Pseudonyms are used throughout and
the gender changed where I felt this to be appropriate.

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Introduction

When I first contemplated this book, I had little idea of the many twists and
turns this process would entail. After all, I had not attempted anything
like this before and I was therefore blissfully naïve as to the true extent
of the endeavour. To say this has been a personal learning experience for me
would be a significant understatement. While describing face-to-face
client work as my primary purpose, I am acutely aware that I feel most
grounded when I am professionally in relationship with a young person.
This relationship enables me to express my feelings fluidly within the context
of my client’s being.
To prepare this script was therefore a huge personal paradigm shift.
A concept explored by Thomas Kuhn – a philosopher of science who wrote
The Structure of Scientific Revolution (1962) – who argued that scientific
advancement is not evolutionary but rather a ‘series of peaceful interludes
punctuated by intellectually violent revolutions’. Mine is not a work of
science, nor am I an academic in the accepted sense. Therefore ‘battling’
through the jungle that is my mind, towards a predetermined clearing at
its furthest extent, has at times been intellectually violent and testing for
me – almost physically so. In this context, arriving at my destination, where
clarity becomes possible for others not just for myself, has been a monu-
mental experience. Time will tell if I have been able to achieve this in any
small measure.
When initially invited to write a book on working with children and young
people, I wanted it to be both readable and encourage readers to apply their
own ‘stamp’. What do I mean by this? We possess a uniqueness that is ours:
if we acknowledge this for our clients, it is also true for us as students or
practitioners irrespective of our professional background. I communicate
with clients in a manner that is personal to them irrespective of their age.
Equally, I choose to communicate the person I am rather than someone who
for many years focused on his perceived acceptability (or lack thereof) to
others. There are occasions when I will challenge traditional boundaries that
purport to be child-centred when their authenticity seems to me to be a
superficial and abstract concept.

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Introduction  xiii

As if to underline this, Chapter 13 describes aspects of the current law in


relation to children that has been of central relevance to my developing
therapeutic practice. The administration of the law can significantly bear
upon the emotional well being of affected children. It reaches well beyond
what some might regard as ‘welfare’ issues that, by convention, could be
considered to lie beyond the scope of therapeutic practice. I recognise
that I have elected to develop my child-centred practice in this particular
way and that it is a path that may not be chosen by others. I consider the
person-centred approach to be inherently holistic: I therefore believe it is
reasonable to conclude that legal decisions directly affecting the emotional
development or well-being of children and young people represents a legit-
imate area for the child-centred practitioner’s practice.
My book is not prescriptive: that individuals find a path or way of being
that has meaning for them within a safe and effective therapeutic practice is
central to person-centred values. The practitioner is a therapist who relies not
upon tools and techniques with which to direct the client, but who intuitively
believes that offering appropriate conditions for emotional growth within the
experience of the therapeutic relationship will enable clients to find a way that
has meaning for them as individuals.
Psychotherapy texts addressing the needs of children and young people
invariably draw a distinction between these two age groups. Policies and
practices tend to support this approach by, for instance, separating the needs
of children in primary school education from those engaged in secondary
education. I have elected to write about children as a single group for two
reasons. First, they are holistic beings who, while possessing broadly recog-
nisable stages of emotional growth through which they may pass, are,
within the definition described in this book, children until they reach 18
years of age. Secondly, they experience a series of transitions that may or
may not follow a ‘normal’ sequence as defined by others. I appreciate I could
have perhaps simplified matters for myself had I followed the broadly
accepted pattern, but this would not have permitted me to describe, for
example, the child of 9 years of age who uses speech as his or her preferred
method of communication or the young person aged 14 who has a prefer-
ence for any kind of communication so long as it does not involve talking.
In time, I hope it may be possible for adult-based courses to introduce
students to working with children since many adults seeking counselling
therapy embody experiences from their childhood and adolescence that
shape their lives and can directly influence their decision to seek therapy. My
experience leads me to believe that children who encounter significant
events during their major emotional development period (see Chapter 3)
will find these ‘grow’ (albeit not exclusively) with them into adulthood, in
proportion to the impact encountered as that child. Adult clients may often
express surprise that an event occurring in their childhood can still influence
them, preferring instead to believe that, with time, the recollections had (or
should have) faded or contextualised within their adult frame of reference.
They may not appreciate that the intensity of their childhood experience can
at times be as if they were now that child.

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xiv  Introduction

This book is for students of counselling and qualified practitioners in other


helping professions wanting to extend their training and thereby contribute
to their ongoing development. It is my hope that this volume will find its
way to trainees and professionals in other fields, such as medicine, nursing
and other allied health professions. Student teachers, trainee social workers,
law officers (such as those working in the family courts) and others may find
something here to enhance their professional and personal approach.
Readers may use this text as a tool to assist them find or develop their
personal child-centred approach to children and young people within their
professional field. The book defines ‘child-centred’ within the person-centred
context: however, space constraints have limited me to providing a broad
description of the model developed by Carl Rogers. Those who would like
to learn more about the person-centred modality regarding the overall
approach will find reference to some helpful texts in this book.
Those wanting to enhance their child-centred practice will find affirmation
if they feel the need for it, but I trust readers will also be open to self-scrutiny
and use this opportunity to ‘audit’ existing practices and methods of working
as I continue to do.

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Part I
Theory and Practice

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1
The Person-centred Approach –
Children and Young People

Covered in this chapter:

•• Introduction
•• Carl Rogers’ influence
•• The humanistic/holistic nature of therapy
•• The practitioner’s journey towards self-understanding
•• Developments in the person-centred approach
{{ Focusing-orientated psychotherapy
{{ Pre-therapy
{{ Process-experiential psychotherapy

{{ Other modalities

•• Being ‘child-centred’

Introduction
This chapter briefly describes the person-centred approach and its recent
developments. Just as people are in a constantly moving state of becoming
through their lives, so it is with person-centred therapy.
Carl Rogers pioneered this approach to psychotherapy and, through his
working life, continued to refine his earlier work. It is a lasting testimony to
Rogers that others in the field have continued to explore and develop new per-
spectives, some of which have emerged from societal and technological devel-
opments that have become progressively more manifest since his death in 1987.
A perspective – within the context of the person-centred tribes described
below – is an approach I refer to as ‘child-centred’. This is not a new concept,
for Axline referred to it in her book Play Therapy (1947: 23) and says, ‘The

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4  Person-centred Therapy with Children and Young People

type of therapy which we are describing is based upon a positive theory of


the individual’s ability’. Although it seems to stand independently from the
work of Rogers and others participating in the person-centred development,
her work invaluably describes her non-directive approach to working with
children in a therapeutic relationship in a manner that was person-centred.
In this book, I describe ‘child-centred’ as a way of working with children and
young people whose very core is founded upon the person-centred approach.
It refers to people up to 18 years of age – the age commonly applied to describe
the commencement of adulthood. While I choose not to define clients simply
by the rubric of age, legal requirements and other considerations require prac-
titioners to be alert to differences of age and services provided by others, such
as the National Health Service (NHS) in the United Kingdom.
This age-definition is relevant to NHS mental health provision. Generally
such provision is split between adult services (for people aged 18 and over)
and the child and adolescent mental health services (CAMHS), which typi-
cally includes people up to the age of 16 years. In some areas there may appear
to be a void for people between the ages of 16 and 18, when it might be difficult
to identify the relevant service for referral. Services do not always flow seam-
lessly as children grow towards adulthood. I hope, as the reader progresses
through this text, it will become apparent that, while practitioners have to
work within provisions predominantly determined by others, embodying a
sense of adaptability to meet the needs of individuals is paramount.
I would like to describe four aspects of the person-centred tradition that
are influential in my developing child-centred approach. First, I would like
to illustrate the emergence of Rogers’ thinking (which was not free of contro-
versy) through his own experience and as a result of collaboration with oth-
ers not necessarily in his chosen field. Secondly, I want to touch on the
holistic nature of person-centred therapy and, thirdly, the practitioner’s
ongoing movement towards self-understanding. Lastly, I want to mention
relatively recent developments within the person-centred field.

Carl Rogers’ influence


In A Way of Being (1980: 114), Rogers poses the question:

What do I mean by a person-centered approach? It expresses the primary theme of


my whole professional life, as that theme has become clarified through experience,
interaction with others, and research. I smile as I think of the various labels I have
given to this theme during the course of my career – nondirective counselling,
client-centered therapy, student-centered teaching, group-centered leadership.
Because the fields of application have grown in number and variety, the label
‘person-centered approach’ seems the most descriptive.

Central to this approach is that we all have within us the resourcefulness to


achieve self-understanding, the capacity to change the way we view ourselves

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The Person-centred Approach – Children and Young People  5

(self-concepts), our basic attitudes as well as self-directed behaviour. How-


ever, at any particular point in time – such as the client seeking counselling
therapy – it may not be possible to connect with these resources. It needs the
presence of, as Rogers puts it, ‘a definable climate of facilitative psychological
attitudes’ to tap the energy that is our own resourcefulness (Rogers, 1980: 115).
Rogers is credited for spreading professional therapy beyond psychiatry
and psychoanalysis to all the helping professions – psychology, social work,
education, the Church, lay therapy and others. During his career, Rogers was
criticised for his therapeutic ideas. Yalom (1995: x) said that:

Rogers was attacked for the supposed simplicity of his therapeutic approach, and
many practitioners caricatured client-centered therapy as the method in which
the therapist merely repeats the last words of the client’s remarks. Yet those who
knew Rogers, who watched him interview, or who read his work with care, knew
that his approach was neither simplistic nor restrictive.

The person-centred approach is complex almost beyond explanation


although Rogers could make the complexity of psychotherapy appear, to the
unknowing eye, relatively simple. For instance, he described the develop-
ment of a process conception of therapy consisting of seven stages (Rogers,
1961). He found the deeper the therapeutic relationship, the more difficult it
was to adequately describe, and this continues to be the case.
Rogers believed practitioners should be encouraged to find a way to uti-
lise their own resourcefulness. He described personal learnings that grew
from his experience and wanted others to do likewise. ‘I am not attempting
at all to say that you should learn or do these same things but I feel that if I
can report my own experience honestly enough, perhaps you can check
what I say against your own experience and decide as to its truth or falsity
for you’ (Rogers, 1980: 6–7). I seek to offer a person-centred approach to
children and young people drawing upon Rogers’ foundations as well as
referring to the work of other thinkers, such as John Bowlby on attachment –
further developed by his son Richard.
Others added to the evolution of Rogers’ ideas and some, such as Skin-
ner, so contradicted his beliefs that he was able to find affirmation and
reassurance in the path he was taking. When researching this chapter, I
encountered many writers whose work helped to shape Rogers’ ideas,
not only fellow psychologists but also that of philosophers, theoretical
physicists, chemist-philosophers and historians. I shall explore the work
of others in the field of child therapy: they too have provided me with
inspiration.

The humanistic/holistic nature of the therapy


I have long regarded the person-centred approach to be a humanistic or
holistic form of therapy and often describe the approach in this way to

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6  Person-centred Therapy with Children and Young People

young potential clients. People are unique individuals worthy of recognition


for who they are and who they can become. Clients are the embodiment of
their entire being and not just what they may perceive to be acceptable or
otherwise to others and thus to themselves. This section describes the terms
‘humanistic’ and ‘holistic’ more fully and describes their context to the
therapeutic conditions.
Rogers’ ideas about holistic therapy can be traced to a paper clarifying
his thinking about the foundations of a person-centred approach (Rogers,
1963). He also spoke of a second source that ‘can be traced to a seed of
thought that germinated at a conference in the early 1970s’, leading to his
paper ‘The Formative Tendency’ (Rogers, 1978). He found similar ideas in
earlier work by two individuals. Smuts’ Holism and Evolution (1926: 98)
claimed:

There is no doubt that the whole is a useful and powerful concept under which
to range the phenomena of life especially. But to my mind there is clearly much
more in the idea. The whole as a real character is writ large on the face of Nature.
It is dominant in biology; it is everywhere noticeable in the higher mental and
spiritual developments.

Smuts remarks that ‘The whole-making holistic tendency, or Holism, pre-


sent in particular wholes, is seen at all stages of existence’ (1926: 97).
Moreover, ‘We find thus that Evolution possesses a specific holistic char-
acter, operating through and sustaining the forces and activities of Nature
and life and mind, and giving evermore of a distinctive holistic character
to the world. This fundamental feature of the world we call Holism’
(Smuts, 1926: 106). Later, Adler used Smuts’ idea to state that, ‘there can
no longer be any doubt today that everything we call a body shows a
struggle for complete wholeness’ (1938: 68). Rogers comments, ‘It has
been very confirming to find that this holistic force – almost totally
ignored by scientists – was understood by these thinkers long ago’ (Rogers,
1980: 113).
To apply Smuts’ thinking to the human condition, we might refer to his
view that:

When an external cause acts on a whole, the resultant effect is not merely
traceable to the cause, but has become transformed in the process. The
whole seems to absorb and metabolise the external stimulus and to assimi-
late it into its own activity; and the resultant response is no longer the passive
effect of the stimulus or cause, but appears as the activity as a whole. (Smuts,
1926: 122)

For example, an anxious parent (or significant other) may unwittingly


communicate their anxiety to their offspring who, in turn, ‘absorb and
metabolise’ that state and reflect it as their own.

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The Person-centred Approach – Children and Young People  7

The practitioner’s journey towards self-understanding


In his foreword to Person to Person: The Problem of Being Human (a collection of
papers contributed by different authors) (Rogers and Stevens, 1967), Rogers
describes comments by his co-author Barry Stevens thus:

They are highly personal feelings and thoughts which [individual papers] trig-
gered off in her [Stevens]. It is as though a friend told you of many responses set
off in himself by something he had read. So you are stimulated to read the mate-
rial yourself to see what you can get out of it. This seems like a natural approach,
but it is certainly not a conventional one. It is simply not the way books are
written or compiled. (p. ix)

In her introduction to the same book, Stevens states:

The client-centered approach to interpersonal relations cannot be followed in the


usual sense, which is a kind of copying. It requires that a person start from the
same point that Rogers does – a point that has to be arrived at by each person in
himself. From that point, which is central to himself, of necessity his mode will
be his own, his course an exploratory one, made with the knowledge that there
are no final answers, that a readiness to correct mistakes works out better than
trying (not) to make them. (p. xvi)

I too want to emphasise that this book on child-centred therapy should not
be thought of as an attempt to promote ‘best’ practice. More than anything,
I hope it will encourage readers to make their personal journey and to see
what they derive from their own experiences.

Exercise

How psychologically self-aware are you? In working with younger clients why is
it important to communicate openly?

Developments in the person-centred approach


Rogers regarded his work as evolving and his theories as continuing to
develop. In The Tribes of the Person-Centred Nation, an introduction to the
schools of therapy related to the person-centred approach, Sanders (2004:
i) describes his ongoing ‘learning about the many ways in which practi-
tioners express their person-centredness’. Progressively, the classical
model of person-centred therapy has accommodated other specific sub-
modalities meeting criteria described by Schmid (2003). Further growth

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8  Person-centred Therapy with Children and Young People

will occur; the emergence of a ‘child-centred’ form is but one part of this
process.
Working with children and young people presents circumstances when ele-
ments of the already recognised ‘tribe’ of person-centred approaches might be
utilised. These approaches include three that come into my work with chil-
dren and young people: focusing-orientated psychotherapy, pre-therapy and
process-experiential psychotherapy. I briefly describe them here.

Focusing-orientated psychotherapy
Eugene Gendlin, a student and later colleague of Rogers, was the first to
develop theory and practice arising from, yet at a tangent to, Rogers’ work
(see Hendricks, 2001; Purton, 2004a, 2004b). Focusing-orientated psycho-
therapy sets out first to help clients better engage with their experiencing.
Therapists assist clients to become aware of blocks to the flow of experienc-
ing. It particularly involves the therapist ‘being’ with the client in a way that
nurtures the natural process of healing.
I often see children immediately after school and there are occasions when
a child might, for instance, be tired from the day’s demands. With a client
who knows me reasonably well and has a confident awareness of the thera-
peutic relationship, I might suggest we spend five minutes or so to focus.
This can help younger clients become more centred, enabling them to
enhance their experience of the time they spend with me.

Pre-therapy
Pre-therapy evolved from Rogers’ (1957: 96) concept of psychological contact.
As he described, ‘all that is intended by this first condition is to specify that
the two people are to some degree in contact, that each makes some perceived
difference in the experiential field of the other’. Dion Van Werde and Gary
Prouty (2007: 238) describe pre-therapy as ‘a theory of psychological contact
specifically designed to provide concepts of treatment and measurement’.
Of pre-therapy, Prouty (1976, 1990) says psychological contact is a precon-
dition for person-centred therapy in relationships that are ‘contact impaired’
(Wyatt 2001) and apply, for instance, to people suffering psychotic function-
ing, such as schizophrenia, those with learning difficulties and others with
dementia. Sanders (2007: 118) comments:

It is a way of being for special occasions. Its essential protocols are derived from
the need to make the most basic of relationship moments with another human
being, and so are incomparable with other applications of Rogers’ work. Yet
pre-therapy is without doubt one of the purest incarnations of person-centred
communication.

Working with children who have, for instance, an intellectual difficulty,


I might experience features of what can be appropriately termed pre-therapy.

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The Person-centred Approach – Children and Young People  9

Elements of such an approach might seamlessly find their way into a session
with a young client, but only post-session reflection is likely to make this
evident. Moreover, since clients, and not the practitioner, decide the activities
they want to engage in, these activities may co-incidentally embrace pre-
therapy attributes.

Process-experiential psychotherapy
Julian Hart (1970) advanced the view of there being three periods in devel-
oping the person-centred approach: non-directive psychotherapy, reflective
psychotherapy and experiential psychotherapy. Between 1957 and 1970,
Hart defined the movement of the experiential period towards ‘a focus on
general therapist attitudes and abilities that could be communicated via a
wide-range of therapist behaviors’ (Hart, 1970: 10). The focus was upon a
client’s experiencing and, further, expression of the therapist’s experiencing.
Sanders (2007) refers to Warner’s description of levels of ‘interventive-
ness’ that are derived from non-directivity. She defines this as the ‘degree to
which the therapist brings in material from outside the client’s frame of
reference and the degree to which this is done from a stance of authority or
expertise’ (Warner, 2000: 31). While generating controversy in person-centred
circles, Sanders mentions that its proponents ‘frequently reassert the links
with Rogers’ work and continually refer to the humanistic underpinnings,
the centrality of Rogers’ conditions to the therapeutic process, the right of
the client to self-determination and collaboration’ (Sanders, 2007: 117).

Process-experiential psychotherapy can find its way into my sessions. I recall an


8-year-old child who initiated a role-play activity in which she was the teacher
and I was the pupil. This enabled her to explore feelings around being in charge
and, for example, play with the blinds in the counselling room and to give
instructions to me – the pupil. Later she told me that, at school, she and her
classmates were not permitted to touch the classroom blinds. In this activity, my
client was able to adjust the blinds: I was not allowed to do so!

Other modalities
There are no theoretical or practical boundaries that would inherently limit the
‘family’ of therapies. Readers will find innovators in other fields, such as Moon
(2002) in child psychotherapy; O’Leary (1999) in couple therapy; Gaylin (2001) in
family therapy; N. Rogers (1993) in expressive arts therapies; Thorne (1991, 1998,
2002) in spirituality; and Cooper (2004) in existential approaches to therapy.

Being ‘child-centred’
I now want to focus upon the provision of a centred approach to working
with children and young people. Usually, when I meet child clients for the

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10  Person-centred Therapy with Children and Young People

first time, I will have already met parents for an intake session, but there are
occasions when this is not practicable. At my first meeting with a child or
young person I outline child-centred therapy in a manner I trust he or she
can understand. Why do I think this is worth doing?
Ideally, at that first appointment, nervous or uncertain clients will start
to feel at ease: I want to foster conditions that feel safe to them. A therapeu-
tic relationship that strives to be equal requires that I am open about the
way therapy works. I believe that clients who have an opportunity to
understand the child-centred approach are likely to relate more confi-
dently. Explaining the therapeutic model offers shape and texture to the
therapeutic relationship – what it will feel like to spend time with me. The
description also allows them to relate my explanation to their life and
experience. I believe these elements are central to therapy. ‘How does this
therapy work and where am I in all this?’ Almost from the beginning, cli-
ents can begin to sense how they might feel in the process of therapy.
There are times, for instance, when I am meeting with a child who is under-
stood to be quite anxious, when I will explain that we can readily understand
some of our feelings. However, we may be unaware of others that might be
preventing sleep or affecting dreams and nightmares. I might use the image of
the iceberg that illustrates our consciousness (above the water’s surface) and
our subconscious state (below the waterline) (see Figure 1.1).

Figure 1.1  T
 he Iceberg – a metaphor describing the conscious and
subconscious mind

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The Person-centred Approach – Children and Young People  11

I offer clients the opportunity to control and ‘own’ their personal emotional
process and while they may not be ready to take control in the early stages of
therapy, they will be aware that it is available to them when that time comes.
If I do not take care to describe the therapeutic approach, then I feel I am, from
the outset, making a judgement about the person I am seeking – in time – to be
alongside. Moreover, withholding information from a client can inappropri-
ately place the practitioner in a position of power and a client can seem to
become the follower in his or her personal process rather than its director. I
will also seek the child’s agreement to my asking parents if they have any
questions they would like to ask and mention that if, following the session, he
or she has any questions about how therapy works, then parents may be able
to provide the answers or clarify those with me directly.
When I visited Parma Cathedral a few years ago, I saw a statue that was
in a somewhat unusual position. Statues are normally placed against a wall
but this one occupied a space that made it possible to walk completely
around. As I looked at this from different angles I saw things I had not previ-
ously perceived. It occurred to me that this statue was not unlike the client–
practitioner relationship and that it might offer me a way of explaining our
individuality to young clients. Clients may have a particular view of their
circumstances from where they stand but because I am located in another
position, I may see something different (Figure 1.2).
Our detailed descriptions may be at variance with each other but it is still
the same statue. Likewise, these perspectives are not a matter of right or
wrong, but are simply two perceptions explained by the fact that we are
uniquely individual and therefore we cannot expect to see things in exactly
the same way.
If parents want their child to explore aspects of their lives and experiences, to
understand the extent to which certain events or relationships may have influ-
enced him or her, the child-centred approach may be a suitable path to take.
Given the opportunity, clients can usually make this assessment for themselves.
Clients with previous experience of counselling therapy – usually younger
people in their teens – will be asked how helpful they found those experi-
ences. Invariably I find that younger clients firmly express their feelings
about the usefulness of the therapy or the practitioner. They have a sense of
what worked for them and, conversely, what did not work. If clients are to
feel that I can be facilitative, then I explain what they might encounter in the
child-centred approach. I am also clear about the differences (if any) in rela-
tion to a previous encounter. To respond in this manner is likely to enhance
their confidence in and ownership of the therapeutic process.

Exercise

Consider how you might adjust your introduction to different people of different
ages in a way that takes account of their existing understanding, therapeutic
knowledge and experiences.

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12  Person-centred Therapy with Children and Young People

Figure 1.2  T
 he Statue – although individual descriptions may differ, there
can be no right or wrong in therapy for it is still the same statue

I seek to embody child-centred principles within the therapeutic relationship


to the best of my ability, in particular the ‘classical model’ described by
Merry in The Tribes of the Person-Centred Nation (2004: 21–4). When explaining
the person-centred model to a client, I do so making it relevant to each indi-
vidual. While its foundations do not alter, I seek to offer meaning to young

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The Person-centred Approach – Children and Young People  13

clients in an understandable context within which they can begin to make


sense of their own thoughts and feelings. On a deeper level, it is evident that
describing the child-centred principles can provide instant illumination for
clients who have previously been unable to work out why, for example, they
feel the way they do in certain situations.

Exercise

Prepare an aide-mémoire identifying the significant points you want to describe


to prospective young clients.

Practitioners need to establish their own form of words to describe the


person-centred approach as they experience it. At this stage, it might seem
unduly daunting (as it was for me in the early days) to describe the person-
centred approach to young clients. For instance, the word ‘unconditionality’
is frequently used in the context of one of the (adult) person-centred core
conditions (see Chapter 2). Many people may not be familiar with the term
but how do you explain this to an 8 year old?

Summary
This chapter seeks to facilitate the reader’s exploration of child-centred therapy
from within their respective professional field – to see what they get from it.
Therapists and others in the helping professions need to be psychologi-
cally integrated and this is central to the development and maintenance of a
meaningful therapeutic relationship. These are evidenced in the personal
experiences of Carl Rogers and how they influenced his work.
The concluding part of this chapter demonstrates the evolving nature of the
client-centred approach in diverse directions. Certain members of the ‘tribe’ of
therapies, such as focusing-orientated and process-experiential psychother-
apy and pre-therapy, feature in a child-centred approach to psychotherapy.

Suggested further reading

Axline, V. M. (1947). Play Therapy. New York: Ballantine Books.


Cooper, M., O’Hara, M., Schmid, P. F. and Wyatt, G. (eds) (2007). The Handbook of
Person-Centred Psychotherapy and Counselling. Basingstoke: Palgrave Macmillan.
Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy (8th edition).
Pacific Grove, CA: Brooks/Cole.
Mearns, D. and Cooper, M. (2005). Working at Relational Depth in Counselling and
Psychotherapy. London: Sage.

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2
Child-centred Therapy – An
Introduction

Covered in this chapter:

•• Child-centred therapy and the ‘tribes’


•• Child-centred therapy – background
•• Developing a child-centred approach
{{ Child-centred overview
{{ The Conditions Model: psychotherapy and the foundation of child-centredness
{{ The ‘core conditions’: adapting the theory to a child-centred context

{{ The actualising tendency and the child-centred client

{{ Locus of evaluation and the child-centred client

Child-centred therapy and the ‘tribes’


So far this book has described person-centred therapy and its development
by Rogers, often collaboratively with others. However, since Rogers’ death
his original theories and commentaries have continued to evolve. Prominent
in this sense of direction is the development of the so-called ‘tribes’ of person-
centred therapy.
Sanders (2007), writing on the family of person-centred therapies and
modalities, referred to the work of innovators in their fields, including Moon
(2002) in child psychotherapy. Moon described child-centred therapy theory
as fitting ‘within the rubric of Carl Rogers’ theory as described in his 1959
statement about therapy and personality’ (2002: 485–6). This rubric states:

Although the therapeutic relationship is used differently by different clients, it is


not necessary nor helpful to manipulate the relationship in specific ways for

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Child-centred Therapy – An Introduction  15

specific kinds of clients. To do this damages, it seems to us, the most helpful and
significant aspect of the experience, that it is a genuine relationship between two
persons, each of whom is endeavoring, to the best of his ability, to be himself in
the interaction. (Rogers, 1959: 213–14)

Moon explains: ‘I think of my work with child clients as being consistent


with the nondirective client-centered psychotherapy to which I aspire in my
work with adults’ (2002: 485).
In common with Moon, my work with children and young people is con-
sistent with person-centred principles, not only non-directively but also in
circumstances when it is appropriate to be available as a guide (see Chapter 8).
At the boundaries of its definition, the word ‘directive’ may infer the appli-
cation of direction towards and compliance by the therapist to younger
clients. However, I believe there are occasions when it can be in the service
of younger clients to offer – appropriately – the means by which it will be
possible for them to view their experiencing from an alternative perspec-
tive they are able to assimilate for themselves and at a pace that feels rea-
sonable for them.
I feel it is now time to give child-centred therapy its rightful place as a
full member of the person-centred group of therapies. At any point in their
lives, all people – irrespective of age – embody the sum of their experi-
ences: personal, relational and environmental. As human beings, we ‘accu-
mulate’ experiences and try to find a way of placing those events within a
context that may permit us to continue with our lives. These experiences
contribute to our individuality and have the capacity to influence the paths
we might take.
Occasionally, childhood experiences can be so traumatising that the events
remain inaccessible to the adult conscious mind. Nevertheless, even if events
cannot be cognitively recalled, they can profoundly influence an individu-
al’s capacity to make and maintain relationships. In other instances, there
may be only a fragment of conscious memory available to an adult in rela-
tion to a painful childhood experience.

Child-centred therapy – background


Even before undertaking research for this book, I had come to believe that
person-centred therapy had been developed, characteristically, as an
approach to facilitate work with adult clients. I felt concerned that my early
training, founded on adult psychotherapy practice, would not enable me to
offer therapy to children and young people. It seemed as if the person-centred
approach was unsuitable for young clients, especially since it was popularly
described as a ‘talking’ therapy. How could children be ‘made’ to talk when
this was unlikely to be their communication method of choice? Little did I
then appreciate that children can comfortably converse within a therapeutic
relationship using a form of communication called play.

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16  Person-centred Therapy with Children and Young People

Note: Utilising play as a means of communication is not to be confused


with the term play therapy, in which practitioners may adopt a variety of
tools and approaches from different modalities that can include the person-
centred tradition. Play in this context relates solely to the child-centred
approach.
Reviewing material about the person-centred approach for this book was
even more revealing. I found a handful of hypothetical references to children
but was unable to relate the appropriateness (or otherwise) of person-centred
therapy to children and young people. My enquiries took a decidedly posi-
tive turn when I looked at two ‘bedrock’ sources: Rogers’ PhD thesis,
completed in 1931, and his book, Clinical Treatment of the Problem Child,
which was published in 1939, after more than ten years of daily clinical
experience of working with children.
In 1928, aged 26, Rogers joined the Child Study Department of the Rochester
Society for the Prevention of Cruelty to Children, and the 1939 book demon-
strates his movement away from the psychometric measuring approach of
professional psychology towards his increasing interest in practical
approaches to helping children and parents. He addressed ways of under-
standing children’s treatment through modifying the environment and
addressing the individual’s needs. Below is a quotation from his first
chapter, ‘A Point of View’:

In this book we shall deal with the child, not with behavior symptoms. One will
look in vain for a chapter on stealing, thumb sucking, or truancy, for such prob-
lems do not exist, nor can they be treated. There are children – boys and girls –
with very different backgrounds and personalities, and some of these children
steal, and some of them run away from school, and others find satisfaction in
sucking their thumbs, or in saying obscene words, or in defying their parents; but
in each instance it is the child with whom we must deal, not the generalization
which we make about his behavior. (Rogers, 1939: 3–4)

Rogers discussed approaches used in assessing and analysing children at his


clinic in Rochester, one of which was known as the ‘Component-Factor
Method of Diagnosis’. He described it as a ‘practical tool for the worker deal-
ing with children, both as a means of diagnosis and as a helpful way of plan-
ning effective treatment’ (Rogers, 1939: 40). Nevertheless, he also detailed the
shortcomings of this tool in its attempts to aid objective analytical thought.
Rogers’ idea of holistic therapy was published in his paper ‘The Formative
Tendency’ (1978). From the onset of life, human beings already possess the
means to be acknowledged for their uniqueness and individuality – to be
their own person. I contend that holism is an appropriate building block
upon which to promote the health and emotional well-being of children and
young people. Smuts (1926: 259–60) describes ‘personality’ as ‘the supreme
embodiment of Holism’ and states that, ‘ignoring the individual uniqueness
of the Personality in each case, psychology deals with the average or gener-
alised individual; and then only from the purely mental point of view, which
is but one aspect of Personality’.

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Child-centred Therapy – An Introduction  17

A client brings to therapy the sum of past experiences and it is not enough
simply to categorise children any more than it is appropriate to ‘classify’
adults in a similar vein. A child-centred approach requires children and
young people to be respected for their whole being and it is inappropriate to
seek a ‘fix’ for a child who may exhibit what may be regarded as unaccepta-
ble behaviour. It is necessary to understand the context within which that
behaviour is communicated.
Utilising my experience of working with adults, I have developed a child-
centred model of therapy within the person-centred tradition that is com-
bined with specified child-based training. I believe that Rogers’ work
provides strength and stability upon which to develop a child-centred
model but its evolution requires reference to the work of authors in other
fields of therapy, including Violet Oaklander. Her book, Windows to Our
Children (1988), describes a Gestalt Therapy approach to children and ado-
lescents, and contains material that is equally applicable to person-centred
therapy. Oaklander says, ‘Often children are forced to lie by their parents.
Parents may be too harsh or inconsistent, may have expectations too difficult
for the child to meet, or may not be able to accept the child for who he is. The
child is then forced to lie as a form of self-preservation.’ A child may believe
his own lies and weave ‘a fantasy around the behavior that is acceptable to
him’. Fantasy thus becomes ‘a means of expressing those things that he has
trouble admitting as reality’ (1988: 11).
Rogers emerged from studying clinical psychology at the University of
Colombia, gaining his PhD some three years after starting work at Roches-
ter, and moved towards a client-centred approach to psychotherapy that
was to respect the essence of client individuality. His thesis, completed in
1931, was a study of the results from a test given to children at the Institute
for Child Guidance (Rochester), and to two other groups of children outside
the Institute.
One year after the publication of Clinical Treatment of the Problem Child
(1939), Rogers gave a talk at the University of Minnesota (December 1940)
entitled ‘Newer Concepts in Psychotherapy’. This presentation came to be
regarded by some as the genesis of client-centred therapy. Of the response to
that episode, Rogers later wrote, ‘I began to believe that I might personally,
out of my own experience, have some original contribution to make to the
field of psychotherapy’ (Rogers, 1974: 8 and Barrett-Lennard, 2007: 24).
Evidence indicates that Rogers’ work with children contributed to his grow-
ing belief ‘that the subjective human being has an importance and a value which
is basic: that no matter how he may be labeled or evaluated he is a human per-
son first of all, and most deeply’ (Rogers and Stevens, 1967: x). In The Carl Rogers
Reader (Rogers, 1990), Rogers states his development of an instrument ‘to assess
a child’s background and current situation and to help plan his future’, that
helped to focus his career ‘on the field of psychotherapy’ (Rogers, 1990: 203–4).
Rogers’ work with children was evidently influential in his developing
psychotherapy experience. However, the growth of a child’s emotional
development from before birth towards adolescence and eventual

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18  Person-centred Therapy with Children and Young People

adulthood appears not to have been addressed in the person-centred


approach. It is not clear why this should be the case, for there are countless
examples in major texts on person-centred therapy of adults recounting
significant childhood experiences that have hugely influenced their life and
relationships. For example, Mearns and Thorne (1988) describe a client,
Joan, who was aged 28 when she commenced therapy. At her sixth session,
Joan ‘spoke at length of the hitherto unmentioned fact that her father had
regularly used her for sexual intercourse when she was aged between thir-
teen and sixteen. Sometimes the sexual intercourse would be preceded by
various acts of physical cruelty.’ Joan also spoke with bitterness about her
mother’s role:

I kept quiet about it just like daddy said for ages and ages, but I kept hoping that
mummy would find out. One time I thought she must have found out when she
came in early and found me crying on the bed. I felt so bad – more than anything
else I felt so guilty that she had found out – but I wanted her to find out. She left
my room without a word and went downstairs. I kept waiting for her to come up
again but she never did and I fell asleep. The next day she acted like nothing had
happened – and so did I. (Mearns and Thorne, 1988: 121–2)

This is a poignant example of an adult woman speaking of events in her


childhood. Her monologue is that of a child: it is as if the narrative relates
to events that have only just occurred. It is not unusual in established
therapeutic relationships for clients to relive significant traumatic experi-
ences as if they recently took place, even though those events occurred
decades earlier.
My practice includes children, young people as well as adults: when I
meet with adult clients who have encountered significant life events as
children, I am aware that I sometimes tell myself: ‘If only they could have
found help much sooner, then they might have had a chance to place
these experiences into a better context in their lives’. Instead, events such
as those experienced by Joan generated difficulties in her marriage that
initially led to her seeking therapeutic help. Occasionally, on the same
day, I have seen a young child whose pattern of personal experience has
been not dissimilar to that of a subsequent adult client’s childhood expe-
riences which came to be both influential and enduring for that adult. In
this way, I am able to glimpse – if only fleetingly – one perspective of a
child’s emotional development that, if left unaddressed, could grow with
that child into mature adulthood.

Exercise

Consider the approach you would adopt when working with an adult client and
then compare it with the approach you would take when working with a child or
young person. What differences, if any, distinguish the two approaches?

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Child-centred Therapy – An Introduction  19

Developing a child-centred approach


Child-centred overview
I have evolved a way of working with children and young people based upon
my formal training in person-centred therapy. This has evolved with my expo-
sure to individual clients who have taught me so much, and with the humility of
that experience I continue to learn. The dedication in Winnicott’s Playing and
Reality (1971) – ‘To my patients who have paid to teach me’ – says a great deal
about the nature of the relationship between Winnicott and his clients. Similarly,
I believe I have much to learn and understand from younger clients. They are the
teachers and I am someone who is able to utilise that experience in the service of
others.

Soon after completing my initial training I found myself working with a young
man then 18 years old. Michael was still at school, having missed a year of his
education owing to mental health problems for which he had spent some time as
a hospital inpatient. I worked with Michael for the duration of his final school
year after which he was to have a gap year travelling before starting university.
Michael had struggled to be heard by his psychiatrist, who seemed confused by
his style of speech and seemed not to understand him. I did not have this prob-
lem, perhaps because, in some respects, we were somewhat alike.
One memorable day, Michael likened his emotional and spiritual journey to
that of a train in a tunnel. He explained that while he might look for the ‘light at
the end of the tunnel’, he knew he must reverse out of the tunnel and find an
alternative track, bypassing that tunnel.

This profound remark is one I have never forgotten and indeed occasionally
share with clients. For instance, a client may purposefully look ahead, but it
may be more appropriate to reverse to a past key episode. I feel privileged to
be the bearer of this experience – for I do not own the words as mine – but I
also sense that, in its retelling to older clients, the metaphor carries the added
strength of its youthful origins, and can promote understanding and healing.
Of the elements featuring in child-centred therapy, perhaps the most signifi-
cant is the practitioner’s way of being – reflecting not only the chronological age
of the client but also the therapist’s understanding of the client’s background –
however limited that knowledge. No, I do not assume all children and young
people will be offered a relationship that I deem appropriate for their age group.
Nor do I assume that, for instance, when I am working with a child who
appears to be ‘on’ the autistic spectrum, that that child requires a pre-formed
variant of a child-centred relationship. My relationship with a young client
always respects the uniqueness embodied by that client and I value his or her
individuality as a matter of paramount importance.
Central to the development of a child-centred psychotherapeutic approach
is Rogers’ Conditions Model, which I now describe within the context of
children and young people.

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20  Person-centred Therapy with Children and Young People

The Conditions Model: psychotherapy and the foundation of


child-centredness
In 1957, Rogers described six of these conditions, which he later modified in
the collection Psychology: A Study of a Science (Rogers, 1959). I outline these
below with Wyatt’s (2001) adjustments in italics. If expressed sensitively, a
child or young person can readily understand the conditions in a manner
that has meaning for them. I also describe my child-centred view of the six
conditions, shown in bold italics.

  1 Two persons are in (psychological) contact.


Two people are alongside each other.
  2 The first, whom we shall term the client, is in a state of incongruence, being vulner-
able or anxious.
The first, whom we shall term the client, is in a state of uncertainty, confusion and
worry.
  3 The second person, whom we shall term the therapist, is congruent (or integrated)
in the relationship.
The second person, whom we shall term the therapist, is equal in the relationship.
  4 That the therapist is experiencing unconditional positive regard toward the client.
That the therapist does not assume or make judgements about the client.
  5 That the therapist is experiencing an empathic understanding of the client’s internal
frame of reference (and endeavours to communicate this experience to the client).
That the therapist senses what the client is seeking to express and is able to
describe this to the client.
 6 That the client perceives, at least to a minimal degree, conditions 4 and 5, the
unconditional positive regard of the therapist for him or her, and the empathic
understanding of the therapist. (The communication to the client of the therapist’s
empathic understanding and unconditional positive regard is to a minimal degree
achieved.)
That the client is able to feel, at least to a minimal degree, a sense of safety and
trust in being with the therapist.

If these six conditions exist, and are communicated over a period of time, the
process of constructive personality adjustment will follow (Rogers, 1957;
Wyatt, 2001). Condition six concerns ways in which therapists communicate
their feelings and, for clients, their perception and experience of the thera-
pist’s feelings. Much has been written about care and sensitivity with which
therapists communicate empathy and positive regard (Mearns and Thorne,
1999; Merry, 2002; Tolan, 2003).
For a relationship to be capable of promoting emotional growth, the
above requirements must be present. These conditions apply, as Rogers
puts it, ‘whether we are speaking of the relationship between therapist and
client, parent and child, leader and group, teacher and student, or adminis-
trator and staff. The conditions apply, in fact, in any situation in which the
development of the person is a goal’ (Rogers, 1980: 115).

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Child-centred Therapy – An Introduction  21

Exercise

Thinking about the ‘core conditions’, prepare a presentation to make to a


potential child client of 10 years of age that would help them to understand how
these conditions might apply to them.

The ‘core conditions’: adapting the theory to a


child-centred context
Three conditions have come to be known as the ‘core conditions’. These are:
first, that the therapist is congruent in the relationship; secondly, that the
therapist experiences unconditional positive regard towards the client; and
thirdly, that the therapist experiences an empathic understanding of the cli-
ent’s internal frame of reference. However, the core conditions are meaning-
ful only if all six conditions are present. This part of the chapter describes
the features of the three core conditions with my adaption to a child-centred
framework.
The first condition is congruence. Rogers identified congruence as
‘the most basic of the attitudinal conditions that foster therapeutic
growth’ (Rogers and Sanford, 1984: 1380). He also stated that, ‘The more
the therapist is herself in the relationship, putting up no professional
front or personal façade, the greater is the likelihood that the client will
change and grow in a constructive manner ’ (1980: 115). Bozarth (2001:
191) concludes that the basic premise of the person-centred therapist is
‘that of being transparent enough to perceive the world non-judgmen-
tally, as if the therapist were the other person, in order to accelerate the
formative tendency of the other person toward becoming all that he or
she can become’. A further helpful definition of congruence is offered
by Mearns and Thorne (1988: 75): ‘Congruence is the state of being of
the counsellor when her outward responses to the client consistently
match the inner feelings and sensations which she has in relation to the
client.’
I am also drawn to the view held by Germain Lietaer (2001: 37):

Congruence requires … that the therapist be a psychologically well developed


and integrated individual, i.e. sufficiently ‘whole’ (or ‘healed’) and in touch with
himself (herself). This includes daring to acknowledge flaws and vulnerabilities,
accepting the positive and negative parts of oneself. … Self-knowledge and ego-
strength can perhaps be seen as the two cornerstones of this way of being.
Moreover, congruence and acceptance are correlative; they are two sides of a
same basic variable of openness.

From a child-centred perspective, I prefer the term equal to congruence,


since I feel it gives meaning to a child or young person. It is a relationship

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22  Person-centred Therapy with Children and Young People

in which the younger client and practitioner are equal, unlike the usual
child/adult relationship with which younger clients will be familiar,
where the adult (parent or teacher) is vested with power and authority. I
am not a child’s friend in the conventional sense, for that would itself
represent an attempt by me to exert authority in the therapeutic relation-
ship. In my relationship with a child or young person, I am myself and I
do not put up, as Rogers states, a professional front or façade. I strive to
be genuine in knowing that my genuineness is offering my client the
opportunity to effect ‘change and grow in a constructive manner’ (Rogers,
1980: 115).
Being equal in the relationship lies at the heart of child-centred therapy
and Figure 2.1 illustrates how it is possible to achieve this. For the practi-
tioner and client to be on a similar physical level is an important considera-
tion, as is relational body language that also offers good eye contact by the
practitioner to the client.
Two other aspects of achieving a sense of equality in a relationship are
worthy of attention at this stage. First, I strive to be equal with my clients
while having regard of my need to provide a safe space within which
they may explore their world. I offer a relationship that is respectful and
seeks to meet clients on their level without patronage – itself an expres-
sion of power – or the application of authority. To do this I need to be
grounded, in touch with myself and able to acknowledge the totality of
who I am.
The second feature I want to mention is the importance of being genu-
ine with children and young people. Genuineness is a state of being
when my outward responses to my client match the inner feelings and
sensations I have in relation to that client. Children will quickly spot the
insincere remark and practitioners need to be on their mettle.

Figure 2.1  O
 n Being Equal – in the therapeutic relationship, the practitioner
emphasises the importance of being equal with the client

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Child-centred Therapy – An Introduction  23

I well recall a client aged 8 who asked me for some sticky tape. In a moment of
inattention I told her I did not have any, although I knew where I might find some.
She looked at me, letting me know she was aware of my ‘indiscretion’ before
continuing without the tape. I have never forgotten that learning.

The second core condition Rogers terms unconditional positive regard


(UPR). I tend to use the term unconditionality, loosely defined as being with-
out assumption or judgement. Rogers states that, ‘When the therapist is
experiencing a positive, acceptant attitude toward whatever the client is at that
moment, therapeutic movement or change is likely to occur’ (Rogers, 1980:
115). The therapist is willing for clients to be with their feelings – irrespective
of the emotion – and values clients for who they are without condition.
Merry (2004: 37) says: ‘As with empathy and congruence, UPR cannot be
considered as a skill or one of a counsellor’s repertoire of techniques. It is
part of a person’s system of values and is an integrated aspect of that person,
not something that can be adopted temporarily and, perhaps, inauthenti-
cally in order to fulfil the core conditions.’
When I first meet with a prospective younger client I explain that I do not
make assumptions or judgements about them. I explain to my prospective cli-
ent that I have already met his or her parent(s) and that ‘they told me all
about you’ without mentioning any difficulties parents previously identified
that might embarrass or frustrate the child. Chapter 10 describes more fully
my way of working prior to my first meeting with a child client.
The third facilitative condition is empathic understanding which is expe-
rienced and communicated by the therapist. Rogers (1951: 40) says of
empathic understanding: ‘In client-centred therapy the client finds in the
counselor a genuine alter ego in an operational and technical sense – a self
which has temporarily divested itself (so far as possible) of its own selfhood,
except for the one quality of endeavoring to understand.’ In accepting clients
for who they are, they in turn can become more nurturing of themselves. As
clients increasingly feel listened to, they may become more attentive to their
inner experiencing. Rogers (1980: 117) puts it thus:

As a person understands and prizes self, the self becomes more congruent with
the experiencings. The person thus becomes more real, more genuine. These
tendencies, the reciprocal of the therapist’s attitudes, enable the person to be a
more effective growth-enhancer for himself or herself. There is greater freedom to
be the true, whole person.

Empathic understanding is demanding of the experienced child-centred


practitioner, in whom this facilitative condition is offered equally, whether
to a child of 6 years of age or to a 15 year-old adolescent. This challenge may
lead therapists to work with a more defined age group, perhaps primary
age children (usually up to age 11) instead of secondary school students

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24  Person-centred Therapy with Children and Young People

(usually aged 11 to 18). Some child-centred practitioners may feel more at


ease with a particular age group, although I feel therapists might first
develop their experience across the age range to adulthood. This would
allow them to understand the individual continuum of experience rather
than taking, for instance, a ‘snapshot’ of individual experience starting at,
say, aged 11 – the time when, generally, children commence state secondary
education in the UK.

I recall Angie who was aged 13 when I first met her. Some five years earlier, her
father left the family and her mother became a ‘single parent’. Her mother worked
evenings while she completed her college studies, and Angie routinely took care
of her own needs – completing school work, getting supper and preparing for the
next school day. Although a child minder provided a presence for Angie and her
younger sister, Angie’s sister received most of the support. These circumstances led
Angie to develop a sense of confidence and independence beyond her years.
At her first session, Angie said she did not want to talk and instead sat on the
floor pulling a box of mixed toys from a shelf. Angie took out each toy in turn and
created a stage scene with them. Pleased with the results of her play, she insisted
her mother have a chance to see her work. When her mother came in, Angie was
mildly scolded for being childish. At the next session, Angie played as she had at
her first session. This time and without enquiry, Angie told me she had forgotten
how to play since, at home, she was expected to be like a grown-up and had not
really felt able to play since her father left.
Angie’s mother returned to collect her daughter at the conclusion of the ses-
sion, and Angie told her why she wanted to play. At this point her mother was
able – perhaps for the first time – to acknowledge her daughter’s need. Illustrating
how a child’s development can become compromised by the expectations of
others, Angie embodied an emotional presence that felt out of balance for her.
Through play, this was addressed to her satisfaction.

Exercise

Empathic understanding has been described as ‘most demanding of the experienced


practitioner who works with children and younger people’. What are the major
challenges to be addressed so that a child or young person is able to experience
in the practitioner a ‘genuine alter ego – a self that has temporarily divested itself
of its own selfhood, except for the one quality of endeavoring to understand’?

The actualising tendency and the child-centred client


Rogers (1980: 117–18) asserts that, ‘we can say that there is in every organ-
ism, at whatever level, an underlying flow of movement toward constructive
fulfilment of its inherent possibilities. In human beings too, there is a natural

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Child-centred Therapy – An Introduction  25

tendency toward a more complex and complete development’. The term


often used to describe this is the ‘actualising tendency’.
A moment’s thought about potatoes that I sometimes describe to clients
and which encapsulates an image of the actualising tendency. When Rogers
was a child, the bin storing the winter’s supply of potatoes was in the base-
ment of the family home which had a small window. While the conditions
were far from favourable, the potatoes would sprout pale shoots and try to
reach towards the light of the window (Figure 2.2). ‘The sprouts were, in
their bizarre, futile growth, a sort of desperate expression of the directional
tendency’ (Rogers, 1980: 118). If people can access conditions promoting
their emotional development, they will do so. Conversely, human beings
whose lives have been deeply affected by abnormal events or experiences
will find it hard to move towards the light. Rogers says that the ‘clue to
understanding their behavior is that they are striving, in the only ways that
they perceive as available to them, to move toward growth, toward becom-
ing’ (Rogers, 1980: 119).
A simple illustration of an infant’s inherent movement ‘toward growth’ can
be witnessed in its efforts to walk. All children with the necessary physical and
psychological means will go through a sequence of stages that lead them to
walk. There will naturally be differences in the progress of each child towards
walking – some will walk before they are aged 1, others will take longer.

Figure 2.2  P
 otatoes in the Cellar – Carl Rogers’ image of the human
condition: we strive for growth even in the most difficult
conditions

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26  Person-centred Therapy with Children and Young People

Variations relate to all aspects of child development, including language acqui-


sition and communication, eating, playing and sociability. Children inherently
possess the means for growth and favourable conditions facilitate that growth.
On the other hand, children whose development is adversely affected by unu-
sual events or experiences may struggle to achieve growth. However, they will
strive, as only they know how, to find a way forward. Child-centred therapy
can facilitate emotional growth and self-understanding.

Exercise

Thinking about the actualising tendency defined by Rogers and the first 12 years
of your life, detail the events and people that influenced your emotional growth.

Locus of evaluation and the child-centred client


What is meant by ‘locus of evaluation’? I regard this as the source of infor-
mation providing the means by which an individual is able to work out how
to relate to a given set of circumstances. The human infant being has, at the
outset, a clear approach to values. Hunger is negatively regarded and food
is positively valued. Other needs, such as security and warmth, are also val-
ued. Sudden loud noises and pain are negatively experienced. These are
what are known as internalised values.
As a child gets a little older, there is a growing awareness of externalised
values. These are values reaching the child from an outside source. Essentially,
and from an early age, children develop two primary sources of evaluation –
internal and external – that can appear to become integrated and owned as
such by the individual. It is my experience that, over time, people tend to react
to the external expectations and, more cautiously, respond to the internal feelings
they may struggle to communicate.
Children experience learning from people and events – at school, within the
family and among friends. Learning might therefore come to be regarded by a
child as developmentally more valuable than its intrinsic feelings. The source of
a child’s internalised evaluation, which began almost free of external influence,
is altered by learning that can also be internalised as its own felt experience. In
time, these two primary sources can become so intermingled that it becomes
difficult for children to separate their learnings from who they truly are at their
core. These circumstances may generate inner confusion and conflict to such an
extent that children and young people experience sometimes profound diffi-
culty in working out which is which. In my experience, the prominent ‘internal’
voice usually reflects our learning and not our true feelings.
Figure 2.3 seeks to show how I might describe the locus of evaluation to a
child. I tend to describe babies having a big pot in which, at the time of their birth,
they have a sprinkling of feelings at the bottom. The plan is that, in time, their pot
will have a lot more feelings. As they develop more feelings they also take on

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Child-centred Therapy – An Introduction  27

Figure 2.3  L ocus of Evaluation – the repository of emotional resourcefulness


within each individual comprises both innate and learned
experience

board learning from others. This leads to the pot having a mixture of feelings and
learning, and it can be hard to work out which is which. The illustration uses the
metaphor of rocks (representing learning) and feathers (representing feelings). If
they were on a set of scales, learning would outweigh our feelings.
I am also drawn to a description by Barry Stevens (Rogers and Stevens,
1967: 1). I find this description both delightful and thought-provoking.

In the beginning, I was one person, knowing nothing but my own experience.
Then I was told things, and I became two people: the little girl who said how
terrible it was that the boys had a fire going in the lot next door where they were
roasting apples – and the little girl who, when the boys were called by their moth-
ers to go to the store, ran out and tended the fire and the apples because she
loved doing it. So then there were two of I. One I always doing something that
the other I disapproved of. Or other I said what I disapproved of. All this argu-
ment in me so much (sic). In the beginning was I and I was good. Then came in
other I. Outside authority. This was confusing. And then other I became very
confused because there were so many different outside authorities.

I am reminded of a client (Alan) who never seemed to be able to do anything right


in his mother’s eyes. She was (in his words) forever nagging him to do his home-
work, chores and reminding him how to behave in social situations. Moreover,

(Continued)

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28  Person-centred Therapy with Children and Young People

(Continued)

Alan’s mother thought he was silly and unreliable. She seemed to belittle his
achievements, often by ignoring him, but, on the other hand, any shortcoming (in
her opinion) would be swiftly pounced upon and severely dealt with.
When Alan reached adulthood his mother still wanted to rule his life by telling
him what he should do. He chose a profession but she opposed that too and
whatever he tried to do, Alan could not please his mother. The one thing he
wanted above all else was to gain his mother’s approval but this always eluded
him. Even after his mother died, her legacy lived on and, perhaps in part because
he could no longer seek her approval, Alan developed severe anxiety coupled
with depression.

Summary
This chapter adds weight to the ‘case’ for a child-centred modality. Rogers’
work with children was formative in his developing psychotherapy experi-
ence and provided a foundation for a child-centred model to develop. This
approach respects the uniqueness embodied in a young client, whose indi-
viduality is greatly valued. Moreover, practitioners who are open to their
own experiencing will learn from their young clients.

Suggested further reading

Axline, V. (1966). Dibs: In Search of Self. London: Penguin.


Mearns, D. and Thorne, B. with McLeod, J. (2013). Person-Centred Counselling in
Action, Fourth Edition. London: Sage.
Merry, T. (2002). Learning and Being in Person-Centred Counselling and Psychotherapy
(2nd edition). Ross-on-Wye: PCCS Books.
Oaklander, V. (1988). Windows to Our Children. New York: The Gestalt Journal Press.
Sanders, P. (ed.) (2004). The Tribes of the Person-Centred Nation. Ross-on-Wye: PCCS
Books.
Trotter-Mathison, M., Koch, J. M., Sanger, S. and Skovholt, T. M. (eds) (2010). Voices
from the Field: Defining Moments in Counselor and Therapist Development. London:
Routledge.
Watson, J. C., Goldman, R. N. and Warner, M. S. (eds) (2002). Client-Centered and
Experiential Psychotherapy: Advances in Theory, Research and Practice. Ross-on-
Wye: PCCS Books.

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3
Associated Child-related Theories

Covered in this chapter:

•• Introduction
•• Period before birth
•• Early life experiences outside the womb
•• Forming significant relationships with others
•• Children – the expectations of others
•• Ongoing emotional development
•• Communicating through play

Introduction
The preceding chapters established within the heart of person-centred
therapy a foundation for child-centred therapy. This chapter reviews the
work of some theorists and the contribution they have made to the child-
centred way of being within the context of the six conditions described in
Chapter 2. Bowlby, whose work on attachment theory (1940, 1949, 1951,
1958, 1959, 1960, 1969, 1973, 1980) provided a foundation for understanding
the early parent/child relationship is but one example of a writer who has
devoted significant time and energy to the study of children and young
people. While questioning Bowlby’s limited reference to the father–child
relationship, the context of his early work – during the Second World War
and the immediate post-war years – was influential. On a personal level,
this also reflected his formative personal childhood experiences and the
period in which they took place.

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30  Person-centred Therapy with Children and Young People

Exercise

What do you consider are the major components of a child-centred approach to


children and younger people? Can you identify from other studies a writer whose
work might complement the development of the child-centred model? In what
ways might that writer’s work conflict with the model?

When talking with a new child client, my starting point is the birth of that
child and the uniqueness he or she embodies. While I also think about
experiences a child gains while in its mother’s womb, I may simply
describe the presence of innate feelings that make a child cry because it is
hungry. The newborn baby has not learned to cry for it does so instinc-
tively, leaving the nearby parent trying to work out why their baby is mak-
ing a noise. Perhaps the most obvious reason is the feeling associated with
hunger. Infants do not learn from their parents what they need to do when
hungry: they tell us what we as parents need to learn! I want to outline the
following areas of a child’s early life:

•• period before birth


•• early life experiences outside the womb
•• forming significant relationships with others
•• children – the expectations of others
•• ongoing emotional development
•• communicating through play.

Period before birth


‘When does life begin?’ This is likely to depend upon an individual’s
perspective – personal, religious, cultural and philosophical – but here I
endeavour to steer a middle path. In utero, the foetus is subjected to expe-
riences, such as body rhythms, that reassure, comfort and provide a sense
of security. As well as these essential conditions for growth in the womb,
scholarly studies have established that under certain conditions, prenatal
experiences can cause lasting physical and psychological consequences for
those children. Prior to birth the new baby will have gained experience of
its world. Janov (1977: 22) suggests that ‘the seeds of neurosis begin with
whatever one experiences in life, and life experience begins in the womb’.
He stated that it was possible to demonstrate ‘the unity of body and mind,
to remember and to feel – is a total psychophysiological event’. Further he
remarked, ‘The body is a memory bank that forgets nothing of its experi-
ence even though the mind has dissociated itself from it’ (1977: 284).
A pregnant woman who consumes excessive quantities of alcohol (a toxin)
can cause alcohol to reach the foetus via the placenta, giving rise to conditions

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Associated Child-related Theories  31

that can affect the baby’s nervous system. Similarly, prenatal drug abuse may
not only harm the mother’s health, but some drugs can directly impair pre-
natal development, and infants who are extensively exposed to drugs before
birth can be born passively dependent on those drugs. A study by Davis and
Sandman (2010) found that prenatal maternal stress significantly influenced
the development of the infant. In a paper ‘Twelve Prenatal Senses, Not Five’,
Chamberlain (2003) described the idea of ‘five’ human senses as a ‘dubious
oversimplification’. He suggested that the correct number was between five
and 17 and proposed at least 12 were already operating in utero. A baby, yet
to be born, is subject to events in the womb that can contribute to its early and
ongoing life experience.

Exercise

Consider the conditions a newborn infant might encounter in the first hours of
life. How would you feel when, having been in darkness before your birth, you
suddenly emerge into the intense light of a delivery suite? Describe your
emotions.

Early life experiences outside the womb


New babies have what I might describe to younger clients as a rudimentary
set of feelings that develop as they grow. Of infants, Montessori (1966: 18–19)
describes ‘A being that is born is something more than a mere physical
body’. She comments that a newborn baby has ‘within itself, psychic
[emotional] instincts which will enable it to adjust to its surroundings’ and
possesses ‘latent psychic drives characteristic of its species’. Montessori sug-
gests that a child’s spirit can be so deeply hidden it is not immediately
apparent. She goes on: ‘the very fact that [a child’s spirit] is not moved by
the same type of predetermined instincts that are found in irrational crea-
tures is an indication of the depth of its freedom of action’ (1966: 20).
The Scientist in the Crib (Gopnik et al., 2001) describes a series of studies
on babies’ abilities, including one by Meltzoff and Moore (1983) on a
baby’s ability to imitate facial expressions, such as sticking out their
tongue. Included in the cohort of this study were babies less than a day
old; the youngest was only 42 minutes old. From this work, Meltzoff and
Moore showed that infants had an innate ability to imitate. Gopnik says,
‘It is actually amazing. There are no mirrors in the womb: newborns have
never seen their own face. So how could they know whether their tongue
is inside or outside their mouth?’ (Gopnik et al., 2001: 30). Gopnik sug-
gested that ‘in order to imitate, newborn babies must somehow under-
stand the similarity between that internal feeling and the external face
they see, a round shape with a long pink thing at the bottom moving back
and forth’.

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32  Person-centred Therapy with Children and Young People

Montessori (1966: 33) says ‘man is capable of becoming anything, and his
apparent helplessness as a child is the seedbed of his distinctive personality. …
He develops his various faculties and thus becomes in a sense his own creator.’
She maintains that adults may erroneously believe that it is their personal
responsibility to mould the child and be the builders of a child’s emotional
development. ‘They imagine that they accomplish this creative work [exter-
nally] by the directions and suggestions they give to the child to develop his
feelings, intellect and will’ (Montessori, 1966: 33–4).

Beth, aged 19, was referred to me for therapy by her GP. She spoke about her
anger towards her father, but she was unable to tell him how she felt. Beth said
that when she was 2 years old, her mother died from cancer. She recalled her
father crying in an adjacent room at home and when he became distressed, he
would leave Beth to play and go to that room. Not only did she want to comfort
her father, but Beth was also angry that he ignored her feelings – he seemed to
think he was the only one hurting. She was hurting too. At her last appointment,
Beth said she had decided to shave her head to raise money for a major cancer
charity. A couple of weeks later I saw Beth cycling in the distance. She had
indeed shaved her head and I wondered if she had managed to talk to her father.

Exercise

As a young child, identify the people who were most important to you and why.
Can you think of an occasion when a significant attachment figure caused you to
experience anger or hatred? Describe those feelings in detail.

Even now, I feel that (as mature adults) we have a far from sound under-
standing of a child’s capacity to understand experiences encountered in their
early lives and the emotional impact of those events. Too often parents
assume that it is safe to talk ‘over a child’s head’ when they are young
because they are judged incapable of understanding what is being said.
While a toddler may not comprehend the words being spoken, children can
sense discomfort in that conversation, quietly observing what is occurring.
On occasions a child has known that I had picked up its feelings about an
encounter with a parent. Some might say that I give children too much credit
for appearing to know what is going on, but remember that I refer to the
child’s feelings rather than to his or her intellectual reasoning.

Forming significant relationships with others


Earlier, I touched upon the theory of attachment developed by Bowlby.
Mooney (2010: 6–7) offers her preferred textbook definitions of attachment,
some of which are noted here.

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Associated Child-related Theories  33

•• A strong emotional bond between a baby or young child and a caring adult who is
part of the child’s everyday life – the child’s attachment figure (Honig, 2002).
•• An enduring social tie of a child to a specific person, such as a mother or father
(Moshman, Glover and Bruning, 1987).
•• An affectional tie that one person forms with another – a tie that binds them together
in space and endures over time (Ainsworth, 1967).

We know children develop significant attachments with adults both inside


and outside the immediate family. One particularly influential group in my
experience is school teaching staff. I recall an adult client who, at the age of
11 was asked by her teacher to do a history project. The child (Patsy) had
suffered sexual abuse by a family member and was unable to tell anyone
about it. Patsy regarded her male teacher as an important person in her life
and while she could not tell him about the abuse, she tried to explain this
through her history project. Patsy included in her project pictures of items of
underwear. Upon seeing this, the teacher was horrified and failed to under-
stand what Patsy was trying to ‘tell’ him. Let down by another significant
adult in her life, I was the first person Patsy told (some 30 years later) about
her abuse.
Bowlby qualified as a doctor, a psychiatrist, a psychoanalyst and a psy-
chologist. Personal identity, the sense of who we are, is, according to Bowlby:
‘Closely dependent on the few intimate attachment relationships we have or
have had in our lives, especially our relationship with the person who raised
us.’ He goes on to say, ‘These potent relationships, whether secure or inse-
cure, loving or neglectful, have a profound significance for us and we need
to protect our idealised perception of them vigorously: they may not be
much, but they’re all we’ve got!’ (2005: viii). It may be hard to imagine that,
as adults, we may continue to idealise such relationships, but my experience
indicates this is indeed the case, as evidenced by Alan’s circumstances men-
tioned in Chapter 2.
Bowlby describes the role of ambivalence in a person’s emotional life.
He refers to this as an ‘inconvenient tendency we all have, to get angry
with and sometimes to hate the very person we most care for’. Criteria
for judging the value of different methods of child care ‘lies in the
effects, beneficial or adverse, which they have on a child’s developing
capacity to regulate his conflict of love and hate and, through this, his
capacity to experience in a healthy way his anxiety and guilt’ (Bowlby,
2005: 10).
A child needs a secure relational attachment readily achieved and main-
tained by loving parents. As Bowlby (2005: 15) suggests, ‘If a baby and young
child has the love and company of his mother and soon also that of his father,
he will grow up without an undue pressure of libidinal [attachment] craving
and without an overstrong propensity for hatred’. Paradoxically perhaps,
aggressive behaviour also plays an important role in maintaining emotional
bonds. Bowlby (2005: 86) states: ‘Many of the most intense of all human emo-
tions arise during the formation, the maintenance, the disruption and the
renewal of emotional bonds.’

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34  Person-centred Therapy with Children and Young People

Fisher et al. (1999: 1) say: ‘In general, the time parents in Britain spend
with their children has increased steadily since the 1960s, and risen at a par-
ticularly high rate in recent decades.’ They go on to say:

Though both mothers and fathers have increased the time they spend with young
children, the steepness of this increase primarily reflects a change in fathers’
behaviour. Fathers of young children devoted less than a quarter of an hour per
day to child-related activities in the early 1970s; now they account, on average,
for around 2 hours per day to this. (1999: 3)

Sarkadi et al. (2008) undertook a systematic review covering 20 years,


describing longitudinal evidence on the effects of father involvement on
children’s developmental outcomes. A leading conclusion was that active
and regular engagement with the child seemed to predict a range of positive
outcomes, ‘although it is not possible to say exactly what constitutes fathers’
“effective” type of engagement’ (Sarkadi et al., 2008: 157). They cited evi-
dence supporting the positive influence of father engagement on their off-
spring’s social, behavioural and psychological outcomes:

Father engagement seems to have differential effects on desirable outcomes by


reducing the frequency of behavioural problems in boys and psychological prob-
lems in young women, and enhancing cognitive development, while decreasing
delinquency and economic disadvantage in low socio-economic status families.
(Sarkadi et al., 2008: 153)

Layard and Dunn (2009: 18), commenting on the growing interest in the role
of fathers in the family, say: ‘Fathers are no less important than mothers in a
child’s life. The closeness of fathers to their children influences the children’s
later psychological well-being, even after allowing for the mother’s influence’
(see also Lewis and Lamb, 2006; Burgess 2007). Layard and Dunn (2009: 19) also
quote a German longitudinal study by Grossman et al. (2002): ‘the children’s
relationship with their fathers while they were toddlers predicted their sense of
self-worth as teenagers’. Grossman et al. (2002: 327) comment: ‘Our interpreta-
tion of the unique contribution of fathers through their play sensitivity needs
replication in studies of samples in different cultural and temporal contexts.’
Flouri and Buchanan (2003) described a study using data from the National
Child Development Study (NCDS). The NCDS is a continuing longitudinal
study of some 17,000 children born between 3 and 9 March 1958 in England,
Scotland and Wales and comprises data of 8,441 cohort members of the NCDS,
including complete mental health data at age 16 and at age 33. For 7,563 of these
cohort members there was information on the informant’s relation to the child
at age 7. The study by Flouri and Buchanan stated that father involvement ‘has
received limited attention in recent psychological research’, and again ‘fathers
were often assumed to be on the periphery of children’s lives’. Their study
found that ‘Father involvement at age 7 protected against psychological malad-
justment in adolescents from non-intact families, and father involvement at age
16 protected against adult psychological distress in women’. However, their

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Associated Child-related Theories  35

study found ‘no evidence suggesting that the impact of father involvement in
adolescence on children’s later mental health in adult life varies with the level
of mother involvement’ (Flouri and Buchanan, 2003: 63).
A client, well-known to me, spoke about her 5 year-old daughter Jessica’s
‘temper tantrums’ since starting primary school. Informally, I had met Jes-
sica on a number of occasions. My client said that before starting school,
Jessica would become quite anxious when her father went off to work each
day. Since starting school, however, Jessica had become less secure and
directed her frustrations towards her mother.

The image I formed was that home (the centre of Jessica’s physical world) was
disrupted when her father went off to work. When she started school, I sensed
Jessica felt she was being ‘sent away’ from home. I described what Jessica might
be experiencing and how her mother might address this. I suggested that before
going to school, my client might agree with Jessica what they would do after-
wards and it was important for Jessica’s mother to remember the daily plan. In
this way, Jessica would be able readily to ‘reconnect’ her attachment to her
mother and override her sense of disruption that school seemed to present. I was
pleased to hear this suggestion quickly proved effective.

A study by Heinicke and Westheimer (1966) identified two forms of dis-


turbance of emotional behaviour found in separated children: one of emo-
tional detachment; the other its apparent opposite, an unrelenting demand
to be close to mother. Quoting this study Bowlby says, of ten children, six
‘showed strong and persistent hostile behaviour to mother and negativism
after their return home: no such behaviour was seen in the non-separated
children’ (2005: 95). It is my sense that Jessica’s short-lived episodes of
intense hostility within an otherwise secure relationship suggested her early
school experience upset her equilibrium.
Magda Gerber, who was born in Budapest, believed that adults in Western
countries had become too interested in doing everything to or for a baby
rather than allowing the baby the personal freedom to find their own way
(Gerber, 2002). She shared with other theorists a passionate desire to encour-
age practices supportive of children and families. My eyes alighted on
Mooney’s (2010) description of an occasion when she (Gerber) called a doc-
tor (Emmi Pikler) to visit her daughter Erika who became ill with a sore
throat. Gerber began to tell Pikler about Erika’s condition and the doctor
‘shushed’ her and focused on the child. Respectfully, she asked the young
child what hurt. Two things amazed Gerber: ‘how cooperative her daughter
was with a stranger when she was feeling so poorly, and how serious and
respectful the paediatrician treated her young patient’ (Mooney, 2010: 35–6).
Attachment can predominate at times throughout an individual’s life. In
times of crisis, early attachment figures (such as parents), whose importance
may have diminished as the individual moved towards adulthood, can once
more become significant attachment figures.

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36  Person-centred Therapy with Children and Young People

Children – the expectations of others


Rogers (1961) describes the locus of evaluation in terms of it being external or
internal (see also Chapter 2). He says that ‘evaluation by others is not a guide
for me. The judgments of others, while they are to be listened to, and taken
into account for what they are, can never be a guide for me.’ (1961: 23).
Instead he says, ‘Perhaps the most fundamental condition of creativity is
that the course or locus of evaluative judgment is internal’ (Rogers, 1961:
354). Children incorporate learning from external sources. The younger the
child, the more likely they are implicitly to be led to believe that the only
useful knowledge is learned from others. What they learn is likely to be
accepted without question, and there is an expectation that children conform
to what their learning teaches them. It is therefore hardly surprising that
from an early age a child’s locus of evaluation can become increasingly reli-
ant upon externally generated stimuli.

Exercise

When you think about your self both as a child and as a younger person, what
expectations did you learn from others? In what ways might this learning have
conflicted with your intrinsic values?

Children invariably believe that adults (parents, older family members and
teachers especially) know best, thus eroding a child’s internal system of
belief in preference to the adult’s reasoning or expectations. For instance, a
child hears its parents arguing in an adjacent room and becomes distressed
and cries. A parent rushes to the child’s room to find out what is wrong and
tells the child not to be silly, ‘we were just talking’. The child is worried, but
his/her feelings are trivialised as ‘silly’. The child is confused: he/she
knows the feeling and yet is told the parent is right. Thus, a child’s exter-
nalised learning can dominate its internalised feelings and if unaltered,
these feelings become diminished by the learned views of others. While
children may not comprehend the precise terms of a communication
between adults, they can accurately sense their feelings and express these if
given the means to do so.

Exercise

Both as a child and young person, describe what it might feel like to try to
communicate your feelings vocally to an adult. What circumstances would make
that difficult or facilitative?

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Associated Child-related Theories  37

Ongoing emotional development


A child has the capacity to experience a range of senses and, if appropriately
nurtured, these become a major resource for the child. It is a primal feature of the
human condition that we have an unerring need to feel loved and wanted by
those who are important to us. The nature of this love and want may undergo
some adjustment as we grow older, but it remains with us. It is so powerful we
will do almost anything to feel we are loved – such as the child abused by a sig-
nificant other who is convinced the abuse occurred only through loving intent.
Schaffer (1958) described how during the early months of life, an infant
learns to discriminate a particular figure, usually the mother, and develops
a strong desire to be with her. At about six months the infant shows his/her
preferences in unmistakable fashion. Throughout the latter half of the first
year and for the duration of the second and third years, the child is – as
Bowlby interprets this – attached to his/her parents which means he/she is
content in their company and distressed in their absence. Children have a
view of their world that is more or less represented by the circumstances of
their family. A child may believe that all families operate in a similar manner.
As pre-school children begin to establish friendships with children of a
similar age, they might encounter differences that confirm or perhaps con-
fuse their understanding of their world. A child whose parents are separated
might be puzzled that a friend’s parents live together. Once at school they
join a friendship group and find the breadth of experiences elicited by their
peers greatly expanded. For some this might be overwhelming and hard to
comprehend. In the school setting a child will be faced with new adults –
teaching and other support staff – with whom they are expected to establish
relationships. A child’s world suddenly expands on a scale beyond what
might at first seem comprehensible. Imagine a child whose life at home is
met with ambivalence from a significant attachment figure. That child has
found a way to cope with that situation, but upon starting school comes into
contact with staff who provide a professional, nurturing interest. This sce-
nario can introduce potentially destabilising variables in a child’s life: events
that some adults may regard as unimportant may disturb a young child.
My phenomenological (conscious and first-hand) experience leads me to
believe that a child’s emotional development goes through an intense forma-
tive period of major significance lasting some seven to ten years. Experiences
can have a profoundly absorbent and enduring impact in adulthood. It would
be inappropriate to attempt to define this by age with any accuracy since it is
highly specific and depends upon the conditions of each child’s essential rela-
tionships. However, I would tentatively suggest that its duration could cover
a child’s experiences from about 5 years to the onset of his/her teenage years.
What do I mean by ‘absorbent’ in this context? I have come to recognise
that significant life experiences and events occurring during this intense
period of emotional development can profoundly influence. It is as if certain
events can ‘skew’ an individual’s ongoing emotional growth such that the
impact of those events grows proportionately with the child into adulthood.

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38  Person-centred Therapy with Children and Young People

Figure 3.1  E motional Growth in Childhood – significant experiences


occurring during the formative period of emotional development
grow with that individual into adulthood

I encounter adult clients whose emotional development has been thwarted


by major events. In one instance, a father who committed suicide when my
client was aged 12 led her to feel unable to maintain healthy, meaningful
relationships with adult men.

Communicating through play


A later chapter will explore play in greater detail but here I would like to intro-
duce the concept of play and a child’s use of play as a means of communication.
Play is universal in children and ‘supports a child’s cognitive development,
socialization, physical abilities; in fact every facet of growth and development’
(Brown, 2007: 27). Brown recognises that play is essential in children’s ability
to cope with stress and is a means of managing emotionally challenging expe-
riences. DelPo and Frick (1988) describe the use of play as a therapeutic
modality enabling children to express thoughts and feelings, assimilate reality,
resolve internal conflicts, achieve mastery and cope effectively.
Brown asserts that ‘true’ play is characterised by the child having ultimate
control over play, determining what themes or concepts will be explored to
meet his or her own idiosyncratic needs or interests. Such play might also be
known as child-centred or child-directed play. Conversely, ‘true’ play cannot
be realised if the adult controls the objects or themes, if specific time limits
or expectations are imposed, or if the play is adult-directed, for example, to
impart specific concepts or knowledge. (See also Chapter 8 on directive and
non-directive approaches.)

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Associated Child-related Theories  39

An adult’s conventional mode of expressing thoughts and feelings is generally


that of verbal communication. Children have not developed the same verbal
skills and are more comfortable expressing themselves through play. Landreth
(2002) describes play as a symbolic language that reveals a child’s self-perception
and feelings, and reactions to experiences, wishes, wants and needs.
According to Lowenfeld (1969: 156):

Children appropriate the materials they find to hand, and invest them with
imaginative qualities that make them a vehicle for the concepts, wishes, and
phantasies that surge within their heads. Having created the elements they need
for their play, they proceed to combine them in ways which enable them to
express the underlying ideas they are trying to grasp.

Lowenfeld goes on to say that the more primitive the material, the more suit-
able it is for this.
At a few months, infants become fond of a special (transitional) object and
develop an attachment to that object. Such special objects continue to be
important and parents get to know their value and carry them on journeys.
Winnicott (1971: 4) says of such an object, that the mother ‘lets it get dirty
and even smelly, knowing that by washing it she introduces a break in con-
tinuity in the infant’s experiences, a break that may destroy the meaning and
value of the object to the infant’. I can well recall negotiations with my chil-
dren when a particular article needed to be washed. They might sit by the
washing machine waiting for it to finish: sometimes I thought their atten-
tiveness was to make sure we did not attempt to introduce a substitute.
Winnicott (1971) developed the concept of ‘transitional phenomena’ to
describe the intermediate area of human experience between inner reality and
the external world. Typically, a baby might have a soft cuddly identified (by
Winnicott) as a transitional object – the first not-me possession of the baby. The
attachment of infants and toddlers to their transitional objects is as important
as their attachment to significant human beings. A child who wants to hold on
to its object long after his/her friends appear to have discarded theirs, may
experience feelings around insecurity or a need for safety. On the other hand,
his/her friends may still have theirs but might be too embarrassed to ‘own
up’! Figures 3.2(i) and 3.2(ii) depict cuddly toys drawn by two children.
Figure 3.2(i) is especially interesting since it shows the cuddly ‘holding’ the girl.

Exercise

Did your favourite ‘transitional object’ have a name? Describe how important this
was to you and how you felt when it was not nearby.

A child’s feelings about attachment and separation are primal: they are
instinctual and not learned. Play affords children the means to explore and act

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40  Person-centred Therapy with Children and Young People

Figures 3.2(i) and (ii)  T


 ransitional Object – a baby’s first ‘not me’ possession
as important as its attachment to significant adults

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Associated Child-related Theories  41

out feelings, ideas and events. It also provides a safe environment within
which children and some young people experience the means to develop self-
acceptance. Axline (1947: 10) says the ‘individual needs the permissiveness to
be himself – by himself, as well as by others – and the right to be an individual
entitled to the dignity that is the birth right of every human being in order to
achieve a direct satisfaction of this growth impulse’. It is similar to Rogers’
description of the actualising tendency attributable to individuals who, when
afforded the appropriate conditions, move toward ‘its own fulfilment, toward
self-regulation and an independence from external control’ (Rogers, 1980: 119).
Behr and Cornelius-White (2008: 2) describe play as one way of ‘working
therapeutically with young people and families within the emerging person-
centred framework’. They go on, ‘This developing work is clearly based on
the person-centred theory of personality, disorder and relationships’. The
therapist ‘monitors all interventions and coordinates all helping initiatives in
which the family is involved’. He or she is a professional responsible for
providing holistic ‘person-centred facilitation with children, adolescents,
parents and families’.

Summary
This chapter introduces writers whose work is consistent with the person-
centred approach.
The period before birth provides infants in utero with lasting physical or
emotional life experiences. Expectations of others play a significant part in
the formation of a child’s view of him/herself. While possessing an internal-
ised system of belief, this can be influenced by the absorption of external
values. Individuals have an unerring need to feel loved and wanted and, if
necessary, will invert evident negative attitudes expressed by significant oth-
ers in order to appear to be valued.
Infants adopt transitional objects that eloquently express powerful feelings
and possess the means to use their transitional object to communicate instinc-
tual emotions. Children use play as a means of communication and, given
appropriate conditions, can utilise play to develop a sense of self-acceptance.

Suggested further reading

Bowlby, J. (2005). The Making and Breaking of Affectional Bonds. London: Routledge.
Eliot, L. (1999). What’s Going on in There? New York: Random House.
Gopnik, A., Meltzoff, A. N. and Kuhl, P. K. (2001). The Scientist in the Crib: What Early
Learning Tells Us about the Mind. New York: HarperCollins.
Loomans, D. with Godoy, J. (2005). What All Children Want Their Parents to Know.
Novato, CA: HJ Kramer with New World Library.
Montessori, M. (1966). The Secret of Childhood. New York: Ballantine Books.
Mooney, C. G. (2010). Theories of Attachment. St Paul, MN: Redleaf Press.

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4
The Emerging Child-centred
Practitioner

Covered in this chapter:

•• Getting started – a personal overview


•• The effective therapist
•• Challenges confronting the therapist
•• The practitioner’s relationship with parents and guardians
•• Confidentiality

Getting started – a personal overview


From a variety of professional and personal backgrounds, adults are drawn
to working with children and young people having their own reasons for
wanting to work with people in that age group. Chapter 1 observed that the
client-centred approach to interpersonal relations ‘requires that a person
start from the same point that Rogers does – a point that has to be arrived
at by each person in himself’ (Stevens, in Rogers and Stevens, 1967: xv). I
want briefly to describe my complex and muddled journey towards work-
ing with children and young people. Counselling training followed 30 years
in administration and management and while I eventually found my path,
to suggest it was a planned change of direction could not be further from
the truth.
Some seemingly unknown force propelled me towards this: an inner
mechanism influencing but ignorant of its presence. I started full-time
work a few months prior to my seventeenth birthday without ambition.
My academic achievements were equal in their emptiness! After climbing

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The Emerging Child-centred Practitioner  43

a few rungs of the employment ladder within the same organisation,


I realised what I lacked in education I made up in my ability to connect
with others. With little authority to demand results, I found I could gen-
tly persuade other colleagues – invariably senior people – to help me
solve a problem simply because they wanted to rather than had to. For
instance, I would go and see the person I needed help from rather than
telephone. On the ’phone I was just the voice of nobody but meeting a
colleague was different.
Beginning my counselling training, I first traced ‘strands’ of experience
that reflected my need for emotional expression with others. The young
clerical officer, devoid of status and authority, who engaged with his inner
resourcefulness, was real and valued. In my youth, circumstances gave me
little choice – I had precious little else to offer – but as a therapist I wanted
to be me and not someone who acquired and then deployed technical skills.
Person-centred therapy training was to emotionally awaken me although,
almost to the completion of my course, I was immersed in conscious self-
doubt alternating with an inner certainty.
Training enabled me slowly to acknowledge the profound influence my
childhood and teenage experiences had upon my sense of being. It gradually
dawned on me that I wanted to work with children and young people, hop-
ing that I might offer clients a way of exploring their world towards their
own emotional growth.
Over a period of more than three years following my Diploma training,
I undertook a Certificate course in child psychotherapy and play therapy,
followed by a Diploma in Play Therapy. I felt my way and continue to do so
knowing that in my work with children and young people I continue to
learn from them and about myself. To quote a phrase by Rogers, I remain in
a ‘state of becoming’. I am no expert but I know my experience – especially
my mistakes – enabling me to increase my understanding and perceptions
of the human condition.

The effective therapist


Practitioners and other professionals in their chosen field need to feel at
ease with what they are doing and must provide safe practices both for their
clients and themselves. Professionals in training (as well as those undertak-
ing professional development) have to start somewhere and should not
expect to achieve too much too quickly. Mearns (2003: 42) maintains practi-
tioners ‘do not need to have resolved all their personality conflicts [before
they commence practice] – some of these conflicts can be made safe through
awareness and management’.
Rogers (1939) refers to three qualities required of the therapist who works
with children: objectivity, respect for the individual and an understanding of
the Self. He points out that the essential qualifications of the therapist are

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44  Person-centred Therapy with Children and Young People

primarily ‘in the realm of attitudes, emotions and insights rather than in the
realm of intellectual equipment’. He also says:

Psychotherapy does not in some mysterious way add to the individual, nor does it
change his capacities or abilities ... It is in the truest sense a process of release, a
process of freeing the individual from obstacles, conflicts, and emotional block-
ings which inhibit normal development toward maturity. The reliance of the thera-
pist is not entirely upon his own skill, but in the drive of the individual toward a
comfortable social adjustment. Every child or adolescent wants to achieve, wants
to be loved, wants to be grown up. It is the work of psychotherapy to release these
normal desires and allow them to function. (Rogers, 1939: 284–5)

In addition to such a releasing process, Rogers observes, ‘psychotherapy


brings results because learning takes place’ (p. 285). While I agree with the
essence of this observation, I feel a distinction exists between the concept of
a younger client learning from, for instance, the expectations of others (out-
side the therapeutic relationship) and finding personal acceptance within a
therapeutic relationship for himself/herself. The practitioner provides facili-
tative conditions that, at the outset of therapy, suggest the therapist can be
more accepting of clients than clients are of themselves. Slowly, this apparent
imbalance adjusts as clients experience a growing self-acceptance that pro-
gressively promotes emotional growth.
Rogers identifies the practitioner’s deep-seated respect for the child’s
integrity. If a child is to gain real help to grow, a relationship ‘where such
growth can take place’ is needed. Rogers explains that, ‘the worker who is
filled with a reforming zeal, or who is unconsciously eager to make the child
over into his own image, cannot do this’. He is unequivocal in stating, ‘There
must be a willingness to accept the child as he is … to work out his own
solutions to his problems’ (Rogers, 1939: 282). Rogers contrasts this view
with clinicians who, judging by their methods, select the goal to be reached
and influence the child in that direction.

Challenges confronting the therapist


Deciding to work with younger clients, practitioners need to question them-
selves about their capacity and preparedness to meet the challenge of doing
so. This process of self-reflection by effective practitioners will beneficially
continue throughout their work.
Mearns (2003) discusses the hazard of therapists needing to appear clever
as their experience develops. He says the notion of being a ‘facilitator’ can
be attractive to practitioners early in their professional development because
‘it does not demand that they behave like the expert which they do not feel.
However, as the counsellor becomes more confident in her work with cli-
ents, merely facilitating the release of the client’s power may become less
satisfying for the person who needs to feel that she is more at the centre of

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The Emerging Child-centred Practitioner  45

events’ (Mearns, 2003: 30). Mearns says that degenerating into an expert
‘may be furthered by the underestimated difficulty of maintaining the per-
sonal, emotional challenge of person-centred work. The approach empha-
sises the quality of the counsellor’s being with the client rather than what the
counsellor does with the client. Maintaining a fully involved way of being
over years of professional practice is much more demanding than develop-
ing a repertoire of things to do with the client’ (2003: 30). This is especially
true for child-centred practitioners.
Geldard and Geldard (2008: 14) caution that ‘sometimes inexperienced
counsellors who are starting to feel frustrated by initially slow progress fall
into the trap of using questioning as a way of trying to move the process
along. Unfortunately unless questioning is used sparingly, the child may
shut down communication for fear of intrusion by the counsellor into pri-
vate and sensitive material.’
Soon after starting to work with younger children, I became anxious
about having an inadequate repertoire of ideas and activities for children
who seemed reluctant to engage with me. I was aware of trawling resources
and undertaking extensive research for I felt I needed to find a way of
becoming more effective in deploying stimulating activities. It took me a
while to appreciate that I was the source of the difficulty and not – as
I perceived it – the apparent awkwardness of younger clients who seemed
to be making it hard for me to do my work! In this context, I was more
concerned with doing than being in sessions that did not seem to ‘flow’ as
I expected them to.
Mearns (2003: 30) says it may be difficult for the practitioner ‘to track the
impact of her pseudo-cleverness on the client because such ways of being
attract expert power to the counsellor and may silence the client in the rela-
tionship’. While Mearns offers this description within the context of adult
therapy, a practitioner working with young children will quickly generate
disaffection with a sense of inequality and ingenuineness. On handling the
interpersonal relationship between therapist and client, Behr and Cornelius-
White (2008: 5) remark that the ‘classic client-centred concept for child
therapy developed by Virginia Axline (1947) is still of key importance …
Axline’s fundamental principles – her respect for the child and their non-
manipulated growth – remain relevant, especially regarding the ethics and
the attitude of the adult person.’ Axline developed eight principles guiding
therapeutic contacts with younger children. Landreth (1991) revised and
expanded these principles, which state the therapist:

•• is genuinely interested in the child and develops a warm, caring relationship


•• experiences unqualified acceptance of the child and does not wish that the child
were different in some way
•• creates a feeling of safety and permissiveness in the relationship so the child feels
free to explore and express self completely
•• is sensitive to the child’s feelings and gently reflects those feelings in such a manner
that the child develops self-understanding

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46  Person-centred Therapy with Children and Young People

•• believes deeply in the child’s capacity to act responsibly, unwaveringly respects the
child’s ability to solve personal problems, and allows the child to do so
•• trusts the child’s inner direction, allows the child to lead in all areas of the relation-
ship and resists any urge to direct the child’s play or conversation
•• appreciates the gradual nature of the therapeutic process and does not attempt to
hurry the process
•• establishes only those therapeutic limits that help the child accept personal and
appropriate relationship responsibility.

Landreth offers space for the child to develop freely: the child moves
about in the therapeutic space – is free to choose and play his games. The
therapist affirms, gives permission and, by verbalising the child’s expe-
rience, refrains from judgemental comment. The therapist joins in the
play or becomes more personally involved at the child’s explicit invita-
tion. This concept is based on a change process in which congruence
increases in the child through unconditional acceptance offered by the
practitioner.
West (1996) says that from the outset, what the therapist says and does
is as important as the feelings behind the therapist’s statements and
actions. Also that a personal challenge facing therapists working with
younger children is to ‘recapture the world of make-believe in which they
lived as a child, and to harness an intuitive understanding of the child’s
inner world with a willingness to learn the youngster’s method of com-
munication’ (West, 1996: 149). I found this a struggle and one that only
became truly apparent when I started professional training to work with
children. In later reflections I wondered if my adult training had appeared
to give me ‘permission’ not to reflect on the significance of my childhood
experiences. I recall my distress in a play training session when I blurted
out, ‘I don’t know how to play’. The course had been set a task and I sat
there watching other members doing the task except me. Paralysed with
the enormity of my anxiety, this realisation enabled me slowly to come to
terms with yet another element of my self-understanding I needed to
explore.
Practitioners using a child-centred approach need to examine their atti-
tudes towards children, and their understanding of the role of children in
society. Therapists need to be aware that changes occur in attitudes towards
children, both within one culture over a period of time (De Mause 1974;
Pollock, 1983; Ariès, 1986; Humphries et al., 1988) and between strata of
society and different cultures. Understanding our own cultural backgrounds,
culturally laden beliefs, values and assumptions is important. While learn-
ing about different cultures and their mores, therapists retain the uniqueness
of each child by avoiding stereotyping within cultural groups. Hoare (1991)
holds that the therapist must recognise that families are experts in their own
realm of experience and what is functionally adaptive for one person may
not be so for another.

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The Emerging Child-centred Practitioner  47

The practitioner’s relationship with parents and


guardians
I have become increasingly aware of the need to involve parents in the
process of therapy. Parents initiate the majority of referrals of children and
young people and therefore make the first contact with me. In school-based
therapy, for instance, it may vary since some parents may be indirectly
associated – the referral being initiated by teaching staff.
Much of my work is centred upon children and young people within a
family setting (Figure 4.1) and I feel it is important to include parents (or
other appropriate adults) in the process.

Figure 4.1  T
 he Family – in some form, is influential in a child’s emotional
development

The extent to which parents participate will depend upon the age of the child
or young person involved. Given parents’ feelings and beliefs when they
bring their child to therapy, Crane (2001: 85) describes how the ‘attitude the
therapist has toward the parents can affect how therapy proceeds and
whether or not parents continue to bring the child to therapy’. She goes on,
‘Overall, the therapist should convey an attitude of empathy, respect, accept-
ance, and hope toward the parents’ (2001: 85). I have reservations about
conveying hope in the manner described by Crane and prefer the phrase
used by West (1996: 46): ‘It may prove helpful, and is honest, to say that …
therapy is often beneficial, but its “success” cannot be guaranteed’. Also, ‘it is
important that the therapist not just have these attitudes, but that the parents

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48  Person-centred Therapy with Children and Young People

perceive them from the therapist. The objective is to facilitate the parents’
potential to learn, to explore themselves, and to grow’ (Crane, 2001: 85).

Exercise

Putting yourself in the place of your prospective client, consider how you would
feel about meeting a therapist for the first time? Remember you have to relate to
the child in you and not from your adult perspective. What differences do you
observe in the way you engage at these two levels?

West cautions that therapy should not be seen as a ‘dumping job’ with the
therapist ‘sorting the child out’ and heroically solving all the family’s prob-
lems. When I meet parents for the first time (before I meet with their child)
my assessment takes account of the following considerations:

•• Assessment sessions are, by their nature, unique; no two are identical. At its start I
do not know what will be the outcome and I am open to what emerges as the ses-
sion progresses. One of the following outcomes is usual: parents may want time for
reflection, a date is set to meet the prospective child client or parents decide that
they would like to meet with me again prior to me seeing their child.
•• The process embraces Rogers’ core conditions, especially congruence, uncondi-
tionality and empathic understanding. It enables me to understand, for instance, the
extent to which both parents support the need for my therapeutic participation. An
ambivalent parent is unlikely to provide a firm foundation for a meaningful parent/
therapist relationship.
•• Our conversation involves gathering detailed information about their child, both fac-
tual (such as the child’s age, health and school) and subjective (relationship with other
family members and friendships). I seek to learn from parents and allow them to feel
listened to: I want to understand them as fully as they will permit me to know them.
•• Each parent’s individuality and the extent to which they jointly relate to my prospec-
tive client are important. Do they work together in making joint decisions on matters
of importance or is there a tendency for the child successfully, but perhaps uninten-
tionally, ‘to play one parent off against the other’?
•• Parents need to feel that, on their assessment, I am the appropriate practitioner to
work with their child and I have to answer their questions openly and genuinely.
There are times when I feel that working with parents instead may helpfully address
the difficulties they perceive with their child. If they are agreeable, they may feel
able to generate the change they need for their family to progress.
•• Discussion includes my giving information about the ongoing sessional arrangements
with their child and contact provisions during the therapy period. I will refer to such mat-
ters as confidentiality, communications parents may wish to initiate with me between
sessions and other practicalities. If we agree that I will meet with their child, I outline the
next session so they can answer questions the child may have prior to meeting me.
•• Contact may be initiated as a result of teaching staff observing unusual behaviour in
that child. It is not uncommon for a child to express behaviour at school that greatly

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The Emerging Child-centred Practitioner  49

differs from their demeanour at home and vice versa. Occasionally I sense a child’s
behaviour may appear to deteriorate for a while before improving and I explain my
feelings to the parents. Some children and young people can, after a handful of ses-
sions, begin to experience an emotional ‘release’ that occurs when, for example, a
client feels listened to and is understood by the therapist, leading to an expression
or outburst of emotional energy that is capable of being misunderstood by others.

Exercise

What personal preparations would you need to make prior to meeting parents for
the first time and how do you maintain your objectivity in gathering information
at assessment? How important is the relationship between you and the prospective
child’s parents? As a parent, describe your approach to an initial meeting with a
therapist about one of your children.

I have experience of parents who have met with me having encountered a


brief or rationed therapy programme provided for their child. Therapy was
said to have made the child ‘worse’ rather than ‘better’. It is my belief that
in some instances, therapy will have stopped at a critical stage when, given
more time, improvements might have been realised.

The behaviour of Anna (then aged 8) at school was causing problems for teaching
staff and peers. Her parents came to see me for help and I explained the possibil-
ity of Anna’s behaviour becoming worse for a little time before starting to improve.
This was likely to be a positive indication that she was gradually becoming more
open to her feelings. At my suggestion, they alerted Anna’s teacher to this possibil-
ity. Early one morning after working with Anna for six weeks, her father rang me
to say that, as predicted, her teacher had reported that Anna had been awful at
school over the previous couple of days. Both he and his wife were pleased with
Anna’s behaviour. To them, this meant she might now begin to be more self-
accepting. Over the coming weeks this became increasingly evident and her
teachers observed a significant improvement in Anna’s demeanour at school.

Confidentiality
The nature of confidentiality and its application to the child-centred approach
is complex. Even now, after some years’ experience, I remain conscious of the
need to be focused on recognising the need for flexibility to reflect individual
differences. Care is needed when describing ‘confidentiality’ to children or
young people. At one time I would suggest that confidentiality was not
unlike keeping a secret, until an adult who had experienced sexual abuse as
a young child told me that ‘secret’ had potentially sinister connotations when

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50  Person-centred Therapy with Children and Young People

applied by abusers. What I might say to children or young people at my first


meeting is that, generally, I am not permitted to tell other people what we talk
about during each session. However, I normally encourage my clients to talk
to their parents and others about what takes place – not necessarily to pro-
vide a detailed account, but for them to feel free to have this conversation.
Some children eagerly tell their parents what they do in each session whereas
others want to keep their process to themselves.
Like Crane (2001: 89), I feel it is normally appropriate to give parents ‘gen-
eral impressions about the session, such as play themes, behavioural charac-
teristics of the child, or concerns about the child, but will not offer specifics
about what occurs in the play-room. The child needs to be able to feel that
the time with the therapist is private and that the parent will not use what-
ever the child says or does against the child.’ I will normally provide such
general impressions at review appointments with parents having first talked
these through with my client.

For instance, I recall talking to Dan (aged 9) about my plan for a meeting with his
parents to review aspects of our first six therapy sessions. Dan’s father had initi-
ated therapy but his mother had been associated with the decision. Dan’s parents
divorced under acrimonious circumstances and I was considering meeting his
parents on consecutive days. I knew from the outset that review sessions would
be difficult for all concerned and in his third session I introduced Dan to the idea
of a review meeting. He was greatly opposed to this but slowly became more
accepting of the idea. By session six, Dan felt able to agree to the review meet-
ings but said he did not want to be present. I agreed with Dan what could be
covered at the reviews and told him when they would take place. At the next
session I told him what I had talked about – he was keen to know in detail.
Thereafter, Dan became sufficiently trusting of our relationship to enable further
parental reviews to take place with the minimum of planning.

Parents and therapist need to trust each other: practitioners need to use
their judgement to decide what to tell parents in the child’s appropriate
interest. This demands care and sensitivity by both practitioner and parents.
If there is something parents feel the therapist should know, then parents can
be invited to contact the therapist before the session. I always inform parents
that what they choose to tell me outside the session will not be referred to by
me within the client appointment. There will always be exceptions but, as a
rule, it is not something I generally permit.

This brings to mind an occasion when a client was brought to his session by a par-
ent who, in my presence, told him to talk to me about a recent incident involving
his behaviour. We did not discuss this in the session. When his mother returned and
asked me if her son had spoken about the event, I said I was unable to talk about
the details of our session and this brought a relieved glance from my client.

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The Emerging Child-centred Practitioner  51

Sweeney (2001: 66–7) says, ‘For the purposes of therapy, confidentiality


may be defined as the client’s right to have communications expressed in
confidence, not to be disclosed to outside parties without implied or
expressed authorization’. He also points out, ‘In most circumstances, chil-
dren need parental consent to authorize treatment … and that confidential-
ity with children can be challenging’. Sweeney described work by Hendrix
(1991) who discussed these challenges and suggested ‘absolute confidential-
ity may not be desirable or required with child cases. He focused on the
concept that confidentiality is for the benefit of the client, and that this ben-
efit may be outweighed by other factors’ (Sweeney (2001: 67). The varying
‘levels’ of confidentiality require sensitive understanding and communica-
tion by the practitioner, influenced by the significance of the relevant issue,
client age and developmental maturity. Sweeney (2001: 67) states: ‘While it
is important to recognize the developmental limitations of children to
understand the abstract concept of confidentiality, it is always better to have
fully explained the process to all involved.’
Here, I can only give a broad indication of the ‘levels’ of confidentiality as
I define them: they serve to portray how I might typically explain the subject
to a child that is, say, 12 years of age or younger.

Minor difficulties – If clients tell me something that is causing them to feel anxious,
and I sense it is quite minor, I might suggest they talk to their parents about their
feelings. I know only too well that some children become quite worried about
something a parent can easily remedy.
Potential problem in the making – In the course of therapy a client might tell me
something that, if not addressed, could become more complicated for my client. I
might suggest I talk to the appropriate adult about this with my client present to
ensure that I accurately represent the client’s feelings. Usually a client will be
content for me to discuss the issue with the preferred adult but might choose not to
be present.
Significant issues – There is also the situation when a client may describe an event
that I feel should be discussed with the appropriate adult since, if unresolved, it
could have significant repercussions for the client and/or others. Again, I will talk
this through with my client and propose that he/she is present when the matter is
discussed.
Statutory reporting – Client confidentiality has to be set aside when a young client
discloses abuse, actual or threatened. In these circumstances, I will implement the
policy set down by the organisation within whose setting I am working – usually
leading to information being urgently passed to the relevant statutory authorities.
Normally I will say to a younger client: ‘If you tell me that something really bad has
happened to you, then I will have to tell somebody else.’ I check my client
understands what I am saying, but if asked for more information, I shall describe this
as appropriately as I am able. Practitioners should be open with clients from the
outset, even though the likelihood of having to pass information to others is slight.
Why do I feel this way? If I do not explain this and, after a number of weeks elapse,
a significant disclosure is then made, it is likely that I will destroy any trust that has
been established with the client.

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52  Person-centred Therapy with Children and Young People

Exercise

Write a description of play therapy for an 8 year-old client using language he/she
can understand. Try this on a willing volunteer (perhaps a course colleague or a
helpful child of appropriate age). How might you adjust this for, say, a 12 year
old? Record your feelings about this experience.

Summary
This chapter emphasises the significance of the practitioner’s deep self-
awareness and their need to feel at ease with themselves. Safe practices must
be provided both for clients and practitioners: do not expect to achieve too
much too quickly and build upon experience.
Self-reflection should be fostered by practitioners and continue through-
out their professional work with children and young people, remaining
mindful of the challenges, including objectivity, adult/child conventions,
external relationships, communication, genuineness and outcomes.
Building effective relationships with parents, guardians or other caregiv-
ers is important in child-centred therapy and should be given appropriate
attention by practitioners.
Confidentiality is complex and requires careful explanation to prospective
clients, parents (and others as appropriate) before therapy commences.

Suggested further reading

Gaylin, N. L. (2001). Family, Self and Psychotherapy: A Person-Centred Perspective.


Ross-on-Wye: PCCS Books.
Geldard, K. and Geldard, D. (2008). Counselling Children. London: Sage.
Landreth, G. (1991). Play Therapy: The Art of the Relationship. Muncie, IN: Accelerated
Development Press.
Landreth, G. L. (ed.) (2001). Innovations in Play Therapy: Issues, Processes, and Special
Populations. New York: Brunner-Routledge.
Mearns, D. (2003). Developing Person-Centred Counselling. London: Sage.
West, J. (1996). Child-Centred Play Therapy (2nd edition). London: Hodder & Stoughton.

04-Smyth_Ch-04.indd 52 19/01/2013 2:50:57 PM


5
Child-centred Therapy – Developing
Practice I

Covered in this chapter:

•• Age as a cultural consideration


•• Other cultural influences
•• Age in a therapeutic context
•• Play and activities in therapy: an overview
•• Emotional development
{{ Early and middle childhood years
{{ Teenage/adolescent years

Age as a cultural consideration


Article 1 of the United Nations Convention on the Rights of the Child (UN General
Assembly, 1989) states:

The Convention defines a ‘child’ as a person below the age of 18, unless the laws
of a particular country set the legal age for adulthood younger. The Committee on
the Rights of the Child, the monitoring body for the Convention, has encouraged
States to review the age of majority if it is set below 18 and to increase the level
of protection for all children under 18.

Chapter 1 provides a working definition of children and young people used in


this book. Challenged to distinguish between these two groups, I would
attempt to do so with reference to the age of each person, by membership of a
family unit and education. Of course, these are subjective measures informed

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54  Person-centred Therapy with Children and Young People

by social constructs and in the context of therapeutic practice. While age may
inform a practitioner’s approach, individual children are genuinely under-
stood when other relevant features are in the therapist’s understanding.
For clarity, I apply the term children to those aged 12 and under and young
people to those aged 13–18. This distinction is founded upon a generally
acknowledged view that, under the age of 13, children are not legally able to
provide informed consent to counselling therapy.

Other cultural influences


The report of UNESCO’s World Commission on Culture and Development,
Our Creative Diversity (1996: 14), makes the following statement:
The cultural dimensions of human life are possibly more essential than growth.
Most people would value goods and services because of what they contribute to
our freedom to live the way we value. What we have reason to value must itself
be a matter of culture. Education, for example, promotes economic growth and is
therefore of instrumental value, and at the same time is an essential part of cultural
development, with intrinsic value. Hence we cannot reduce culture to a subsidi-
ary position as a mere promoter of growth. There is, in addition, the role of culture
as a desirable end in itself as giving meaning to our existence. This dual role of
culture applies not only in the context of the promotion of economic growth, but
also in relation to other objectives, such as sustaining the physical environment,
preserving family values, protecting civil institutions in society and so on.

Socialisation and cultural experience are important in the upbringing and


emotional development of children and young people. The importance of
culture in a person’s life has, according to Glover (2001: 31), ‘a natural place
in the field of counseling. Most therapists are aware of how their role in a
relationship impacts cultures other than their own, and work hard to accept
differences as strengths.’ She explains the importance of understanding dif-
ferent cultures while retaining focus upon the uniqueness of each child or
young person. Pescosolido (2007: 611) says:
All individuals in every society have a reservoir of embedded knowledge and
attitudes that they use to address problems in their lives and the lives of their fam-
ily members and friends. These beliefs, values, and norms create a cultural cli-
mate in which children and their parents experience the onset of mental health
problems, seek advice, come to or fail to come to the attention of the mental
health system, and follow or do not follow medical recommendations.

Exercise

Consider what cultural influences might influence your work with children and
young people and reflect upon your personal cultural beliefs, values and assumptions.

An aspect of cultural experience constantly present in my practice concerns


the breakdown of adult relationships and its impact upon children. Gaylin
(2001: 25) says that:

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Child-centred Therapy – Developing Practice I  55

Although cross-cultural comparisons reveal all manner of variations on the typi-


cal monogamous unit we have come to know, marriage remains the most basic
of all human institutions. No other social institution is either so indigenous to us
or so defining of us as a unique species. For all cultures, marriage serves the
universal function of maintaining responsible intimacy.

In 1939, Rogers described the importance for children of a stable parental


relationship and reasoned that if children encountered deep marital friction,
then such conditions were more likely to procure a greater proportion of
children with emotional difficulties.
Working with a child or young person, there is often a feeling for me of
slowing down, for a short time, the prevailing pace at which their lives are
being lived. Even quite young children with busy lives have commented to
me about the calmness and gentleness of the time we spend together. It is
almost as if, for some children, the therapy session can have a restorative
quality. Honoré (2004: 14–15) describes the ‘Slow’ movement – doing things
at the right speed – implying ‘quality over quantity. It is about making real
and meaningful human connections – with people, culture, work, food, eve-
rything, and being present and in the moment’. He quotes Hirsh-Pasek and
Golinkoff (2003) ‘when it comes to raising children the modern belief that
“faster is better” and that we must “make every moment count” is simply
wrong. When you look at the scientific evidence, it is clear that children learn
better and develop more rounded personalities when they learn in a more
relaxed, less regimented, less hurried way’ (Honoré, 2004: 252).
I also want to mention the impact on children and young people of informa-
tion technology. I encounter two associated cultural effects. The first is the use
of social networking sites that can, for some young people, generate an
unhelpful alternative reality and diminish the fostering of emotional confi-
dence in ‘real time’ relationships. The second is electronic games, which are
known to generate addictive behaviour by over-zealous users, diminishing
self-confidence and creating a sense of aloneness.

Paul, aged 9, told me that he was addicted to computer games and unless he was able
to talk to his friends about computer games then he would have no friends. He wanted
to reduce the time spent on his computer but feared this would cause his friends to
walk away. Paul’s dilemma was that being committed to computer games meant he
could have friends, but reducing his involvement would lose him friendships.

Hutchby and Moran-Ellis (2001: 1) state, ‘In most sociological studies of


technology, little account has been taken of children in analyses of major
technological changes and their impact on everyday social and economic
life’. They refer to commentaries in which all too often ‘both “childhood”
and “technology” come to be accorded an unproblematic status, each
treated as having a stable and self-evident existence in which there is a
straightforward impact of one upon the other. This narrow perspective has
been shown to be far from adequate for understanding both childhood and
technology’ (p. 1).

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56  Person-centred Therapy with Children and Young People

Exercise

Cultural needs and influences vary from area to area. What cultural features
might you have to understand where you live? Describe how these features could
influence your approach to working with clients.

Age in a therapeutic context


Cultural conventions are associated with broadly expressed age groups
that, depending upon their specific application, can have markedly differ-
ent meanings. For example, a child aged 12 is valued for possessing a
superior intellect, receiving accolades for academic achievements. Over the
preceding few years, that same child has received rather fewer plaudits for
its emotional being. This can generate an imbalance between the intellec-
tual and the emotional aspects of that child: it might be assumed that an
educationally bright child will also be emotionally and deeply aware. This
can be frustrating for such a child when judged in this way by, for example,
a parent or teacher.
I believe it is unhelpful when social constructs override the recognition
of individuality. While a person referred to by age may afford a prelimi-
nary insight as to the possible emotional disposition of an individual, it
provides only limited information. Cultural perceptions can lead the inex-
perienced practitioner to formulate a preliminary judgement about an
individual based predominantly upon the chronological age of that indi-
vidual. Nevertheless practitioners need to adhere to age-related proce-
dures such as consent requirements (see below).

Exercise

A 12-year-old client tells you that he is worried about his anger. When you ask
him what he may be angry about, he says he does not know. How might you help
him to explore his feelings?

It is possible that a child in his/her early teens will have a broader range of
life experiences than a child half that age: certainly older children may have
greater exposure to potential experiences than a young child. However, I can
think of young children who have been exposed to traumatic events and
teenaged clients whose experiences have, to date, been relatively uneventful.
Sociologist Allison James pointed out that chronological age is also of lim-
ited use when comparing childhood across different cultures and societies:

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Child-centred Therapy – Developing Practice I  57

A ten year old may be a school child in one society, the head of a household in
another. As such, the new sociology of childhood prefers to identify a ‘plurality
of childhoods’ rather than one structural conditional term. This plurality, it has
been argued, is partly reflected through the prism of children’s own definition of
themselves. (James and Prout, 1990: 59)

Hendrick (1997) speaks of a new modern notion of childhood being in


place in Britain by 1914. Childhood was, he said, ‘legally, legislatively,
socially, medically, psychologically, educationally and politically institu-
tionalised’ (p. 34). Within these different contexts, concepts of age have
been socially constructed and care is needed so that conflicting constructs
are effectively ‘managed’ in therapeutic practice.
Provisions in relation to informed client consent are a case in point. Gener-
ally, in the UK, children aged 16 and above can give their own consent
although in some instances, such as counselling therapy, this might be at age
13. For younger children, their ability to understand what is being asked of
them should be assessed so their voluntary consent supports the formal con-
sent required of parents or recognised others. In child-centred therapy, con-
sent applies to the process of therapy, the circumstances of which may alter
during the course of the therapeutic relationship. For me, this is more com-
plicated than providing consent for a specific procedure, such as dental
extraction. Writing on the matter of informed consent, Sweeney (2001: 68)
comments:

The consent of clients must be given in a voluntary, knowledgeable and compe-


tent state. This is where the issue becomes complex for child clients. Because of
their minor status, children are not considered voluntary, knowledgeable and
competent clients … The very concept of informed consent is sophisticated and
abstract, and as such is counter to this basic rationale for using play therapy.
Informed consent remains, however, a therapeutic imperative.

I will normally see parents of prospective child clients under the age of 13
prior to meeting the child, at which time I obtain their informed consent.
When I then meet my prospective client, I also seek his/her agreement to
an initial therapy session. At the conclusion of that session, I will ask the
child if he/she would like to meet again. The younger the child, the more
likely I am to ask this question in the presence of a parent and consent is
sought.
With children aged 13–15, while I may not require the informed consent
of parents, I believe it is good practice to have their ongoing support. In
private practice, parental support is necessary in order to receive payment
for work undertaken. This is not the case in providing, for example,
school-based and other-funded counselling services where young people
may not wish parents to be associated with their therapy. The involvement
of parents in these circumstances is generally a matter of confidentiality,
not consent.

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58  Person-centred Therapy with Children and Young People

Play and activities in therapy: an overview


I tend to distinguish between play and other activities. While this may appear
to be a little confusing, experience has led me to reason that with younger
teenagers, using the term ‘play’ is unlikely to bode well for a successful
therapeutic relationship. I prefer the generic term ‘activities’. And while art,
for instance, may suit both children and young people, it is likely that the
initial focus for teenagers will be upon conversation. However, I know that
once a therapeutic relationship becomes established, young people may feel
able to initiate activities. West (1996: 34) puts this succinctly: ‘In view of the
therapeutic need for many older distressed children to regress, to play, and
to re-experience missed childhood stages, the therapist may begin the ses-
sions on an age-appropriate level.’ She goes on to say: ‘When the time is
right the child will drop his or her defences and will play’ (1996: 34).
It is broadly reasonable to anticipate that a young child up to 10 years of age
may utilise toys or participate in other activities within the therapeutic session
and that a young person of 13–14 years of age or older will prefer speech as
their preferred manner of communication. That is as close as I can come to
equating the generality of age with experience. Practitioners need to feel their
way and provide appropriate space for clients to decide for themselves.
Before meeting a child or young person for the first time, I will normally
have gathered background information from parents or others to help me gain
some understanding of my prospective client. I do not, however, make any
assumptions as to what kind of activities I might offer that client, but I might
ask about their interests and how they might like to spend their time with me.

When Katy (aged 10) came to see me with her mother for the first time, she was
shy and said little. I sensed Katy might be more at ease if she could bring some-
thing familiar with her to the next appointment when her mother would not be
there. I suggested this to her and her eyes lit up. At subsequent appointments, a
favourite cuddly would accompany Katy.

Children may use play as their sole means of communication and/or they
might choose activities that enable them to talk while they work with their
preferred activity. This allows them to use the activity as a diffuser – to com-
bine what they are saying with what they are doing. Older children between
10 and 13 years of age may often use activities in this way. I find the types of
play or activity chosen by children and young people will often depend upon
their perception of what they feel is deemed suitable in the court of their peers.

Exercise

It is important to be open with yourself about your capacity to work with children
and young people. What personal challenges do you need to address in order to
be an effective therapist? How might you address these?

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Child-centred Therapy – Developing Practice I  59

Play typically relates to children’s use of toys and other media, through
which they invent characters and situations – real or imaginary – to effect
control. Landreth (2001: 6) refers to

this sense or feeling of control, rather than actual control, which is essential to
emotional development and positive mental health. Children may experience
environments at home or at school that are overly structured and controlling,
interactions in which they experience being controlled by others, but in unstruc-
tured free play, the child is the master, the boss, the person in control, the one
who decides what to play, how to play, and the outcome.

Specific activities available for young people include detailed construction mod-
els. I recall James (aged 13), who experienced insecurities in relationships and in
his self-worth. He was known to be impatient, rarely completing a task. In therapy,
James decided to build a complicated model that might have seemed ‘unsuitable’
for someone with his reported background. Nevertheless, James completed the
construction and his patience when things went wrong was remarkable. He would
quietly correct the fault then move to the next step. It was with an immense sense
of achievement that he showed the completed model to his parents.

Emotional development
Emotional development is another feature that is hard to define other than on
an individual basis. Two theorists who have sought to define ‘stages’ of emo-
tional development include Freud’s model of psychosexuality (Freud,
1927/1928) and Erikson’s eight psychosocial stages. Erikson (1977) believed an
adult’s self-esteem was largely dependent upon childhood experiences and
that these can have a profound effect upon an adult’s self-perception. I have
established phenomenologically that childhood experiences and relationships
have the capacity to ‘mould’ major aspects of emotional and relational adult
life. The occurrence in a child’s formative years of significant experiences can
become firmly established as profound influences in the child’s growing mind.

Exercise

Mearns (2003) states that practitioners do not need to have resolved all their
personality conflicts prior to working with children and young people. What
personality conflicts can you identify about yourself? What provision do you
make to ensure appropriate conflicts can be made safe through awareness and
management?

In what may be known as their young and middle childhood years (up to
12 or 13), children can find their sphere of understanding appears to be

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60  Person-centred Therapy with Children and Young People

founded upon the primary centre of their reality – usually the family. When
they enter adolescence, it is not uncommon for their world to expand as
they establish new relationships outside the family and begin to see that
some of their earlier experiences can be different from those of their friends.
The introduction of new subjects at school and the growing pressure to
work independently as well as in groups generates yet further areas for
exploration and comparison.

To illustrate these remarks, I think of a young woman, Caroline, who was 28


years of age when I first met her. She explained to me that, during her primary
school years, a family member sexually abused her on a number of occasions.
Believing this activity was a ‘normal’ loving gesture, Caroline, while still at
primary school, in turn harmed her younger brother. When Caroline began
secondary school at the age of 11, it slowly occurred to her that what was sup-
posedly normal within her family, was not shared by her friends. For the first
time she began to reject the reality that had been her life at home. During our
work over many months, she was able to talk to her adult brother about her
feelings towards him and Caroline decided to dedicate her life to working with
young troubled people.

Early and middle childhood years


Children, in these years of their emotional development, are likely to find
they are influenced by relational experiences and prominent events. While
there may be some uncertainty about the extent to which children are
adversely affected by losses, major transitions such as moving home and
family breakdown, my experience of child clients suggests that such events
can be more traumatic than might first be thought.
Rogers (1961: 192) describes a ‘fully functioning person’ – someone who is
psychologically free and who

is more able to experience all of his feelings and is less afraid of any of his feel-
ings; he is his own sifter of evidence, and is more open to evidence from all
sources; he is completely engaged in the process of being and becoming himself,
and thus discovers that he is soundly and realistically social; he lives more com-
pletely in this moment, but learns that this is the soundest living for all time. He
is becoming a more fully functioning organism, and because of the awareness of
himself flows freely in and through his experience, he is becoming a more fully
functioning person.

From infancy, children experience the need to adjust their ongoing emotional
process to accommodate the needs and expectations of significant people in
their lives. Daily living requires children to adapt and evolve emotionally to
changing circumstances. While the concept of the ‘fully functioning person’
continues to be an important element of person-centred theory, compromise

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Child-centred Therapy – Developing Practice I  61

will be required by each organism (child) in order to survive. All children


experience some diminution of their functioning both in benign and loving
conditions as well as through less positive events and experiences. Children
become quickly aware of their need to adjust – parts of their locus of evalua-
tion being externalised – and the extent to which this may occur will depend
upon the circumstances facing each child.
We know that significant people and events have an important influence
upon a child’s emotional development. The more children refer externally
for their evaluative needs, the greater becomes their dependence upon the
beliefs and values of others rather than on their own internalised emotional
resourcefulness. It can lead to subjugation of a child’s value system in pref-
erence to that of a more dominant other. Some children will find it difficult
to separate their innate feelings from that which has been learned from
external sources.
Research by Cummings et al. (1981) found that in the family context
there are developmental changes in children’s response to anger expres-
sion by family members. At 1 to 1½ years of age toddlers often react
emotionally to anger in others by overt distress or anger. In a study of
children aged 5–9, Covell and Abramovitch (1987) found that the youngest
children in the family cite themselves as the cause of marital anger, but
older children are likely to attribute the cause to siblings, parents and
ongoing family events.

Teenage/adolescent years
Teenage years tend to be characterised as one of change and this can be
accompanied by feelings of insecurity as young people form their personal
identity. Erikson (1963: 262–3) states, ‘the adolescent mind is essentially a
mind of the moratorium, a psychosocial stage between childhood and adult-
hood, and between the morality learned by the child, and the ethics to be
developed by the adult’.
Hawkins (2008) writes about the adolescent ‘culture’ having its own con-
ditions of worth that govern patterns of relating. ‘For example, adolescents
often feel that adults do not understand them and therefore assume that it
would be counter-productive to open themselves up to an adult who is
likely to adopt the parental role of thinking they know best, telling them
what to do or judging them’ (2008: 49). Erikson (1968) argues that adoles-
cents may be fearful of relational intimacy since their individual identities
are insufficiently solid and may fear becoming ‘lost’ in a relationship. Van
Heeswyk (1997: 3) comments: ‘Adolescence begins with biology and ends
with psychology. It is kick-started by puberty and cruises slowly to a halt at
adult identity, the point at which the petrol is getting low and we need to
think about saving it for the long, straight road ahead.’
Reviewing research on counselling, psychotherapy and related practices,
Cooper, Watson and Höldampf (2010: 21) state:

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62  Person-centred Therapy with Children and Young People

Psychotherapeutic treatment for adolescents is often seen as more difficult than


treating children or adults. In order to reach children therapeutically, play therapy
was developed; to treat adults, therapy is usually based on talking. However, for
adolescents neither play nor verbal communication seems to be an adequate
instrument to achieve therapeutic contact. Only recently, in the 20th century,
have modern societies started to understand adolescence as the time when a
young person is trying to figure out who he is, trying to take on the role, no more
that of a child and not yet the role of an adult, a difficult and stressful time each
provides a lot of developmental tasks and opportunities. (see Figure 5.1)

Figure 5.1  W
 ho Am I? – a question particularly poignant to children at the
onset of their teenage years

I close this chapter with a quote from Stevens in Person to Person (Rogers and
Stevens, 1967: 107):

If I move in the direction of being more acceptant of the child’s world as his, and
accepting as his world what he says of himself, and being honest with him about
my world and my own limitations (accepting myself), then both of us are getting
out of whatever degree of trouble we may be in. Children and young people are
helpful to me in doing this because they are still somewhat aliens in our world.
As aliens, they are prone to make some mistakes about it, misconstrue some of
its happenings in terms of their world. But as aliens, too, they are more likely to
see the nonsense of something we have lived with for so long that we don’t notice
that they don’t make sense. They are more questioning than we are. When I join
them in their questioning, I make better sense myself.

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Child-centred Therapy – Developing Practice I  63

Exercise

Reflecting upon your own childhood and teenage years, consider how you
adapted to your changing experiences. What aspects of your life at that time
proved difficult for you and why? Has your experience influenced your views
about working with children and young people?

Summary
This chapter explores age as a cultural consideration in the context of work-
ing with children and young people and other cultural influences.
An overview of play and activities explores their place in child-centred
therapy, particularly in working with children as they move into their teen-
age years.
Emotional development is reviewed and broad patterns of development
in young/middle childhood years and teenage/adolescent years are
described.

Suggested further reading

Behr, M. and Cornelius-White, J. H. D. (eds) (2008). Facilitating Young People’s


Development: International Perspectives on Person-Centred Theory and Practice.
Ross-on-Wye: PCCS Books.
Erikson, E. H. (1977). Toys and Reasons: Stages in the Ritualization of Experience. New York:
W. W. Norton.
Keys, S. and Walshaw, T. (eds) (2008). Person-Centred Work with Children and Young
People: UK Practitioner Perspectives. Ross-on-Wye: PCCS Books.
Landreth, G. L. (ed.) (2001). Innovations in Play Therapy: Issues, Processes, and Special
Populations. New York: Brunner-Routledge.

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6
Child-centred Therapy – Developing
Practice II

Covered in this chapter:

•• Transference and counter-transference


•• Resilience
•• Relational security: teenage years
•• Categories and stages of play behaviour
•• Motivation for change
•• Therapist gender
•• Ending therapy

{{ Ending initiated by a client


{{ Ending initiated by the therapist
{{ Abrupt endings by others

Transference and counter-transference


Transference and counter-transference are terms often associated with
psychodynamic therapy and not the person-centred approach. Transfer-
ence refers to the redirection of a client’s feelings from a significant person
to the therapist. Similarly, counter-transference is defined as the redirection
of a therapist’s feelings towards a client. This occurs when the therapist
conveys elements of his/her own personal internal conflicts to the client.
It may also be described as a therapist’s emotional entanglement with a
client.

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Child-centred Therapy – Developing Practice II  65

The person-centred perspective, on the other hand, places emphasis upon


the nature of empathy and empathic understanding within the therapeutic
relationship. Rogers (1939: 337) states:

The use which the [therapist] makes of the transference, or the emotional bond
between the [therapist] and child, seems to be somewhat less stressed in child
[therapy] than in working with adults. Essentially, however, the therapist expects
the child during the earlier stages of [therapy] to use him symbolically as an
object of emotion, reacting toward the [therapist] as he has reacted in the past to
parents, siblings, or others. The child may become very dependent, or may show
violent resentment and hostility toward the therapist.

Rogers says ‘the aim of treatment is to free the child from this very close
emotional bond, leaving him capable of selecting other love objects’ (1939:
337). Mearns (2003: 57) reminds us ‘in person-centred counselling, empathy
is a core concept, involving a considerable depth of relationship and emo-
tional engagement with the client. In empathy, the counsellor is actually
tuning into the client’s experiencing process and gaining a sense of how it
feels to be him.’
Rogers goes on to say that it is not surprising when a deep bond, extend-
ing over a long period, might make child therapy difficult. He takes the
view that such situations can constitute a threat to parents who may feel
their own position being usurped and he warns that many therapeutic
relationships are broken because parents will no longer cooperate. This
may be true even when the possible situation has been carefully explained
in advance.
I believe that even experienced practitioners may unexpectedly encounter
such difficulties when the therapeutic relationship itself precipitates an
unhelpful imbalance between the client and parents. There are two ways in
which I have encountered this shift: first, when a client encounters a signifi-
cant event during the therapy period, such as the sudden death of a significant
family member, thus rapidly altering the family’s previously relatively stable
emotional dynamic; secondly, where a young client may use the therapist as a
‘weapon’ with which to berate a parent. Imagine the child who remarks too
frequently that their therapist ‘listens to me and understands how I feel. Why
can’t you?’
As I mentioned in Chapter 2, the practitioner is responsible for estab-
lishing and maintaining an equal relationship with his/her client. I
believe this can be effective in providing a healthy balance within such
a relationship. Part of this equality requires practitioners to avoid
becoming drawn into taking sides or passing judgement about a parent.
Geldard and Geldard (2008: 16) say: ‘It is inevitable that transference and
counter-transference will occur at times in the child–counsellor relationship,
but provided this is recognized and dealt with appropriately, then it is not a

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66  Person-centred Therapy with Children and Young People

problem.’ If a therapist feels that transference is beginning to dominate, this


should be discussed with parents and addressed in supervision.

Exercise

Referring to transference in child therapy, examine the circumstances under


which this is considered facilitative to a child’s emotional process.

Resilience
Sometimes when working with a family I am struck by the different ways in
which two children appear to deal with broadly similar experiences.

For instance, I can think of a family of four – the parents had two boys, aged 11
and 15. I became increasingly aware that the boys’ father, an academic, was con-
stantly undermining the emotions and ideas of both children. What I found inter-
esting was that while the older boy (Tim) seemed to develop a stronger sense of
determination as to his interests and ambitions, the younger one (Andrew) seemed
to be crumbling from the almost endless belittling to which he was subjected by
his father. Tim portrayed a sense of becoming stronger and more resilient in his
own identity, but his younger brother was altogether more emotionally fragile.

The construct of psychological resilience – a psychoanalytical term –


describes the ability of individuals who seem able to ‘bounce back’ from
negative events quite effectively, whereas others may become weighed
down by similar events. Tugade and Fredrickson (2004: 320) suggest that
being ‘able to move on despite negative stressors does not demonstrate luck
on the part of those successful individuals but demonstrates a concept
known as resilience’. The state of resilience refers to an individual’s ability
to effectively cope and adapt although faced with loss, hardship or adversity.
Lazarus (1993) likened resilience to elasticity in metals. For example, cast
iron is hard, brittle and breaks easily (it is not resilient), whereas wrought
iron is soft, malleable and bends without breaking (it is resilient).
My own metaphor offers another perspective to the one offered by Lazarus
on the matter of metals and resilience. I sometimes describe the fence that is
solid, appearing to withstand heavy winds, but which in time loses its integ-
rity. However, the fence with gaps in its structure, allows strong winds to
pass through, so there is less strain on the overall structure (Figure 6.1). These
‘gaps’ are analogous with a child’s capacity – when offered the appropriate
means – to accept what cannot be altered and to encourage emotional growth
through the opportunities of its own experiencing.

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Child-centred Therapy – Developing Practice II  67

Figure 6.1  T
 he Open Fence – an expression of emotional openness that
facilitates our capacity to weather difficult times in our lives

Fredrickson, Tugade, Waugh and Larkin (2003) describe a study in which it


was proposed that positive emotions are active ingredients of trait resilience – a
relatively stable personality trait. Fredrickson et al.’s broaden-and-build theory
of positive emotions suggests that recurrent experiences of positive emotions
may help people to develop this trait. Participants in this study were American
college students who, having taken part in a separate study on emotions at the
beginning of 2001, were contacted for this follow-up study in the weeks following
the terrorist attacks on the USA in September 2001.
The findings of this second study indicated that people scoring higher on
trait resilience experienced fewer symptoms of depression in the aftermath of
the attacks, thus hypothesising that ‘this buffering effect is mediated by their
more frequent postcrisis experience of positive emotions’ (Fredrickson et al.,
2003: 367). Wilson (1999: 314), writing on the subject of delinquency, stated that
‘the extent to which children are resilient, and thus able to rise above negative
circumstances or manage to mitigate the effects of these circumstances, is a
major variable’. Horowitz (1987) refers to the complex interrelationship
between children’s inherent vulnerability and the facilitative nature of their
environment: resilient children in adverse environments may make remarkable
progress while vulnerable children in more facilitative ones may not.
From a child-centred perspective, I believe key adults often have only a
superficial understanding about the presence of resilience in children, who
may convey to adults a sense that they can cope or are coping with signifi-
cantly adverse events. My experience indicates that superficial impressions
conveyed by a child towards – for instance – a parent, can be incorrectly
interpreted as resilience in which the child appears to be largely unaffected
by such events. In my experience, children can develop quite sophisticated
constructs, including those aimed at appearing to others as though they are
coping with situations that are in truth both complex and troubling.

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68  Person-centred Therapy with Children and Young People

I am reminded of a girl aged 3 whose parents divorced about one year earlier. Suzie
was a bystander in terms of her parents’ decision and was therefore obliged to work
out her own way of coping. When I first met Suzie about six months following the
parental split, I was able to gain some understanding of the construct she had
affected that allowed her to cope with a bewildering situation. This was how she
responded to the circumstances with which she was faced. Her parents now lived
about 150 miles apart and her father cared for her on alternate weekends.
Suzie appeared to create two ‘compartments’ – one that represented her life
with her mother and the other, life with her father (Figure 6.2).
It seemed Suzie’s construct was effective so long as these two elements
remained separate and distinct. When her two worlds overlapped (or collided, as
it felt to me), it would give rise to inner confusion and distress. This was most likely
to occur when Suzie’s care transferred between one parent and the other. While
not unusual, it provided an enlightening though saddening insight into the com-
plicated construct that, at such a young age, Suzie had been obliged to develop.

Resilience in a child may appear superficially to equate to emotional


strength. Some children, who may be regarded as emotionally ‘strong’, may
become hardened or inured to their emotional experience and repress or
question the integrity of their feelings. I have found such strength can in

Figure 6.2  Compartments – intuitively constructing compartments permits


children to cope with sometimes ‘falsely’ separated aspects of
their lives

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Child-centred Therapy – Developing Practice II  69

time become weakening. Resilient individuals may be emotionally self-


contained and may be reluctant to ask for help, believing that if they cannot
solve their own problem then nobody else can. I take the view that a child or
young person seeking therapeutic support does so from a position of
strength; they are more likely to be aware of their need for help and are
therefore more likely to be open to the idea that someone else might be able
to provide support.

Exercise

Would you describe yourself as resilient? In what ways do you consider resilience
to be a positive aspect of your character? Does your capacity for resilience also
have a ‘down’ side?

Relational security: teenage years


Relational security can become particularly significant for children in their
teenage years. Vlerick (2008: 84) describes the need for adolescents to ‘have
the opportunity for existential learning – as an addition to the instrumental
learning they get in traditional education – through an authentic encounter
with others within their environment’. He mentions the presence in early
childhood of provisions for safe attachment relationships, but in the adoles-
cent years, ‘in the so-called second individuation and separation phase, true
contacts with others remain essential. Friendships and relationships with
adults in which adolescents feel safe, understood and supported play an
important part’ (p. 84).
Adolescents can struggle with the ever-increasing lack of connectedness
or relational security. Growing evidence suggests that teenaged pupils often
do not succeed in building up significant relationships. Vlerick (2008: 84)
states that ‘pupils are constantly confronted with parting and the pain this
brings about. Some of them lack the skills or courage to engage in [new]
relationships. They become emotionally isolated.’ They are unable to find
anyone who understands them, a person who listens to them with, as
Gendlin (2005) describes it, real ‘inter-human attention’.
Lanyado (1999: 241) mentions the use of limited therapeutic consultations
to allow teenagers to ‘enter into some thinking and feeling about their diffi-
culties if they know that there is a clear point of separation at the outset that
helps them not to feel trapped into a commitment which they feel unable
and unwilling to make’. In other words, it is not about providing regular
therapy but to help the young person to feel clearer about the distress that
brought about referral, and thereby allow them to be able to understand
painful and confused feelings (Bronstein and Flanders, 1998). Lanyado says

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70  Person-centred Therapy with Children and Young People

that with this pattern of therapy a teenager can dip in and out of consulta-
tions ‘without feeling they have reneged on a therapeutic commitment when
they feel well enough to manage without consultations for a while’ (1999:
241). A teenager can also seek help when the need arises. I endeavour to offer
this kind of support. It ‘feels much more in touch with adolescent process’
and is reminiscent of providing a secure base from which to explore. Vlerick
(2008: 85) observes that ‘life continually expects young people to come to
terms with all kinds of feelings; to give these a meaning or a place; to inte-
grate them psychically. If they succeed, they can further flourish – they can
acquire “food” for the future.’ Deklerck (2005) speaks of this process of mate-
rial, emotional and existentialist integration like a ‘mental composting’ that
enables events and experiences to be ‘digested’, thus providing individuals
with the opportunity to make further choices.

Exercise

As a teenager, what were your experiences of seeking and developing relational


security? Did this generate any particular problems for you?

Categories and stages of play behaviour


What I feel distinguishes play from articulated adult communications is the
presence of a further layer of understanding to which the practitioner needs
to become attentive. Engagement with a child or young person in play
requires focus that, at times, might lead to something significant being over-
looked in the session. When time is taken for post-session reflection, an
important feature of the sessional process may slowly reveal itself. Practi-
tioners, including those with significant clinical experience, might find,
through reflection or discussion in supervision, individual elements that
may seem unimportant but, when combined, provide an insight that might
otherwise be ‘lost’. The indications or signals provided by a young client
may be so subtle or symbolically represented through play that they can be
overlooked.
In seeking to develop a structure of play, various writers have offered
models described in terms of categories or stages that I feel are peripheral to
the child-centred approach. Landreth (2001) recognised that children may
express themselves in many different ways in the playroom. He summarised
seven categories of play behaviour that he described sexually abused chil-
dren often exhibit in play as they begin to work through their experience,
seeking the means to gain some understanding of those events and to heal.
My experience indicates that the categories described by Landreth can be
identified in play where referral centred upon matters other than sexual

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Child-centred Therapy – Developing Practice II  71

abuse. These seven categories reflect Landreth’s considerable practice, and


are therefore worth mentioning because they provide a theoretical insight
into forms of play.

Abreactive play – By definition, abreactive play describes re-enacted experiences


that are repeated over and over again and may literally represent the abuse that
occurred (Ater, 2001). Findling, Bratton and Henson (2006) identified the need for
sexually abused children and adults to integrate the experiences into their life
stories, for which repetition became a necessity.

Aggressive play – Aggressive play may be acted out in therapy and the context in
which aggressive behaviours may occur need to be understood. Abused children
may, for instance, test the therapist’s boundaries during the session as their way of
working through trust issues with the therapist (Kelly, 1995). It is important to
understand the context of aggressive play: a child may be seeking to communicate
something important. This must not be confused with the boy who seems to find
pleasure in playing games of heroes and villains with toy figures, where the meaning
of the play may be less sinister than the aggressive behaviour suggests.

Dissociative play – This enables a child to deny and avoid trauma by emotionally
generating distance from thoughts, situations and emotions. When children
dissociate in play, they are likely to be unable to hear, understand or process what
happens in the session and may eventually develop feelings of depersonalisation
(Gil and Johnson, 1993). In its mildest form, disassociation is a normal human
experience.
Nurturing play – This is important for abused children and those who may feel
unloved. Such play can help them to express feelings about their lack of nurturing
as well as their need for it. Children might exhibit nurturing behaviour by cooking a
meal and feeding the therapist. It is the kind of play that often takes place within the
family when a young child decides to mirror the actions of a parent in taking on the
role of that parent. Cattanach (1992) describes the presence of mixed feelings as a
child makes the therapist ‘poisoned cake’ and then helps the therapist with a ‘magic
potion’.
Perseveration play – This usually manifested as a ‘routine’ which appears rigid and
literal. This differs from abreactive play in that children are not able to ‘change’ the
ending to create hope for them, but get ‘stuck’ in that play. Repetitive play is an
acknowledged feature of children with an autism developmental disorder. For these
children, repetitive play can be both reassuring and enjoyable. Perseveration play
that results from traumatic experience can reflect a sense of hopelessness and a
constant, monotonous, ritualised, re-enactment of the trauma. The play is lacking in
variety, enjoyment and does not provide relief (Terr, 1990: Webb, 1991; Schaefer,
1994).
Regressive play – This is a term used when children revert to earlier ways of
behaving. Some children may regress when pressures are too great or when, having
sustained a traumatic event (Gumaer, 1984), it is a comfort to return in behaviour
and attitudes to a period when they felt safer and less was demanded of them. Others
regress because of the need to re-experience a deep, elemental phase that was not
suitably handled at the time.

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72  Person-centred Therapy with Children and Young People

Sexualised play – This is the most commonly observed behaviour of sexually abused
children (Homeyer, 1994). This arises when such children do not have a true sense
of appropriate touching and boundaries; over-sexualised behaviour can occur in the
playroom (Sagar, 1990). Three types of sexualised play may be expressed during play
therapy: abuse-reactive play, re-enactment play and symbolic sexualised play. The
therapist faces the challenge of finding a balance between allowing children freely
to express themselves and placing limits on behaviour so that children become
aware of acceptable ways of expressing their experience (Van de Putte, 1995).

As Cochran, Nordling and Cochran (2010: 230) state:

When each unique child enters the playroom, she shares with all other therapy
clients a common therapeutic milieu (such as the common therapist role and
skills employed), the human condition and universal developmental challenges,
and the challenges of forming a therapeutic relationship. It is the convergence of
all these common factors that we believe produces some uniformity in the pattern
or sequence in which behaviour and themes emerge over time in play sessions.

Nordling and Guerney (1999) identified four sequential patterns or stages com-
monly seen in therapy. These are the warm-up, aggressive, regressive and mas-
tery stages, but they emphasise that their development of a stage theory
attempts to organise the complexity of what is typically seen throughout the
course of a child’s play sessions. However ‘although often a useful way of
organizing session data and making sense of the therapeutic process, is never-
theless only a conceptual framework’ (Nordling and Guerney, 1999: 17). While
some children do not ‘travel’ through the stages in the order they lay out, others
will not go through these stages. ‘Even in the majority of those children that do
go through the stages, there is great variation in terms of how long a given child
will spend in each stage of the process’ (Nordling and Guerney, 1999: 17).

Exercise

Explore the above concepts of play therapy and draw out your separate experiences
of being both the practitioner and the client. Make a detailed note of your feelings
from both perspectives.

Motivation for change


Elsewhere reference has been made to the need for a young client to feel ready
to change some aspect of his or her life. Regardless of age, motivation is neces-
sary even if at the outset of therapy the client is unsure what may be achieved
through that process. Parents can determine that their child might benefit
from therapy, but if the child is unwilling to participate then a therapeutic
relationship will not be possible. It is therefore important that practitioners
establish that younger clients want to effect change for themselves.

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Child-centred Therapy – Developing Practice II  73

Fear and uncertainty as to what therapy involves can be a major reason for a
child declining therapy. It is also possible that a child may feel strongly that
a problem is not theirs to address but that of a parent or other person. When a
child is reticent about engaging with therapy, he/she might be encouraged by
his/her parents to give it a try. In my experience, younger clients who are open
to the possibilities of therapy will allow themselves to find out what it can do
for them even if, after a while, they choose to end the relationship. Children or
adults who struggle with their emotional experiences may not be able to recog-
nise or acknowledge that they might benefit from external support. Therefore, it
often falls to someone close to that individual to provide some initial impetus.
Carkhuff (1969) states that on the basis of an empathic and congruent rela-
tionship, the general therapeutic attitude has to include positive regard and the
willingness to confront. Writing on person-centred interventions with violent
children and adolescents, Fröhlich-Gildhoff (2008: 96) comments that ‘the
offending behaviour can be explained by a distorted and rigid self-concept. My
hypothesis is that to “reach” the aggressive/violent target group the “basic”
person-centred psychotherapy model needs an extension or specification.’ An
essential first step is to build a motivation for change and, as he points out, ‘it
is very important to work with self-responsibility – to change the “reality-
distortion”, including the “aggression-biased” perception patterns’ (p. 96).
Building an effective relationship with violent or aggressive children and
adolescents is generally demanding. Such clients are not usually motivated
to engage with a therapist or change their behaviour. As Fröhlich-Gildhoff
(2008: 102) says:

Violent children and adolescents are often viewed as resistant or not motivated
to engage in the therapeutic process. They had been acting in a ‘violent way’ for
a very long time – it is part of the self-structure – and this behaviour temporarily
protects their self-esteem.

Initial sessions will seek to build a trusting relationship that can enhance the
client’s motivation progressively to engage in the process of therapy.

Exercise

You are a child who has been having problems at school with friendships. Your
parents are concerned that your behaviour at home is disrupting the rest of the
family and have suggested you should talk to someone. What steps would be
necessary to help you find the motivation to make some changes?

Therapist gender
In relation to child-centred play, Doyle (1990) considers that provided they
have suitable personal qualities, technical knowledge and the intuitive

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74  Person-centred Therapy with Children and Young People

ability to be alongside children, men and women can be equally effective in


the therapy role. Jones (1986) found that, on the whole, the gender of the
therapist was not particularly important. In relation to abused children, West
(1996) says that such children may prefer one-to-one sessions with someone
of the opposite gender. Other children, because of the material they need to
explore, may prefer a therapist of their own gender, while others have no
particular preference.
Lush (1977) subscribes to the view that the therapist can be gender-less in
play sessions, although the importance of unambiguous acceptance by prac-
titioners of their sexuality cannot be overstressed. Being grounded in one’s
own gender identity can enable children to view the therapist as a sexual
being and as one on to whom they can project all sorts of fantasies to do with
male and female figures in their lives. Whether the practitioner is male or
female can become an important consideration for children and young peo-
ple. It is not simply a choice of gender, but also who the practitioner might
appear to represent to that child or young person. For instance, a boy may
choose to work with a male therapist since such an adult may appear to
embody aspects of the boy’s hopes for his father. The male therapist may
(often quite unwittingly) increasingly represent the child’s personal concept
of how he would like his father to be. Such circumstances also gives rise to
possible transference issues, described at the start of this chapter.

I am reminded of Sean, a 12 year-old whose father lived 100 miles away and who
rarely saw his son. I met with Sean for six sessions and then he decided he did
not want to come any more. In fact, Sean chose not to get out of the car for his
next appointment and asked his mother to talk through his decision with me. I
sensed Sean felt I was offering a relationship that only intensified his feelings as
to the fractured nature of his paternal relationship. Sean wanted to continue with
therapy, but told his mother he wanted to see a female therapist. After he had seen
his new therapist a couple of times, Sean’s mother telephoned me to let me know
that he was getting on well in this new relationship. While feeling a little disap-
pointed, I wholly accepted Sean’s decision.

As children move into adolescence, the influence of gender in relation to


their choice of therapist seems for some to become less important. Older teen-
age boys, for example, may choose to work with me because at that stage in
their process they may be seeking to explore personal feelings in relation to
significant male role models in their lives. It often seems that such clients may
want to detach themselves from unhelpful and often hurtful internalised feel-
ings in order to find validation for their growing personal identity.
Scheidlinger (1992) describes therapist gender in child and adolescent
treatment groups. He believes the workability of such groups can be
influential and says: ‘There is general agreement that gender-related
self-categorizations as male or female, intertwined as they undoubtedly

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Child-centred Therapy – Developing Practice II  75

are by biological, cognitive, cultural and emotional elements, constitute


a uniquely stable social identity, beginning with the earliest years’
(Scheidlinger, 1992: 105).

Exercise

How grounded are you in your sexuality? Under what circumstances might your
sexuality feel challenged by a young client and why?

Ending therapy
Ending therapy with a child or young person can be quite fraught. An end-
ing that is permitted to emerge of its own accord will feel comfortable for
both client and practitioner. Rogers (1939: 351) says, ‘any clinical worker is
well aware of the fact that failures in treatment occur as frequently from
inability to bring the process to a constructive conclusion, as from any inad-
equacy of knowledge or skill in initiating treatment’.
As part of my background introduction to young clients (Chapter 1) I
routinely explain that I arrange a parental review session at the conclusion
of each ‘block’ of six sessions. Before that session takes place I will talk to
my clients to find out if they would like to be present at the review
appointment and also what I might mention at, or exclude from, the
review. Generally I find that clients do not want to be at the review,
although they will ask me to represent their interests. If at the review ses-
sion it is agreed that I will provide their son or daughter a further ‘block’
of six sessions, then at my next session with my client I will touch on sali-
ent remarks made at the review meeting. Although I anticipate that parents
will have already talked to their child about the outcome of the review, I
will briefly recount the appointment. A similar process will follow comple-
tion of the next six sessions. If at the conclusion of a review appointment,
parents decide not to continue with therapy, then I will ask for a final
appointment with their child.
Normally, ending therapy should, when possible, be planned ahead of
the last session to enable the relationship to be brought to a mutual and
‘natural’ conclusion. This is what I would term an ideal scenario, in which
practitioner and parents work mutually for the benefit of the client with
evident interest for the child’s well-being. When first working with young
children, the texts I assimilated seemed to give me the impression that this
was the kind of ending I should regard as routine – it was considered the
norm. My early experiences with children caused me to feel anxious and
de-skilled simply because I was not achieving textbook endings. It took me
some while to overcome these negative feelings since, with supervision and

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76  Person-centred Therapy with Children and Young People

practical knowledge, I began to realise that endings were often unpredict-


able and unplanned.
Practitioners electing to develop experience in child-centred therapy should
be prepared for the different kinds of endings they are likely to encounter. I
feel somewhat uncomfortable with formal endings in child-centred therapy
because I believe the client process has not been brought to a conclusion but
rather it has been set on its way. It will hopefully continue to grow and, if the
need arises, clients can ask to see me once again or someone else of their
choice. In my adult practice, it is not unusual for clients to renew contact after
having been out touch with me for a year or more. I can think of a girl whom
I first met when she was 7 years old and I saw her periodically as her needs
determined, for the following nine years.
Therapy should help facilitate a client to have a more meaningful relation-
ship with parents, friends and others in that client’s environment. Rogers
says that if this occurs, ‘a decreasing need for the therapist’s help and a
gradual breaking off of the contact, with friendly interest still maintained,
but no deep rapport. In such a situation the termination of treatment is
decided as much by the child as by the clinician’ (Rogers, 1939: 351). It is a
client’s reduced need for the relationship that will indicate movement
towards the conclusion of therapy.
Rogers describes this as an ‘ideal process’ that often may not or cannot
occur. In these circumstances it is important that the therapist can plan, in
concluding treatment, ‘to transfer the affect which the child has bestowed
upon him to others in the child’s environment’. It is therefore important for the
practitioner to know, prior to the commencement of a client’s last session, that
therapy is coming to an end. This will provide the opportunity needed by the
therapist to bring the therapeutic process to an appropriate conclusion.
If, at the conclusion of a review, parents decide to discontinue their
child’s therapy, I will seek agreement to a concluding session with their
child, enabling me to talk to my client about the review and in particular to
explain the decision to bring therapy to an end. Whenever possible, I feel it
is important for practitioners to have a direct opportunity to bring the
therapeutic relationship to a conclusion. For a moment, consider the child’s
perspective: the practitioner has a session with his/her client when arrange-
ments for the parental review are discussed, including reference to report-
ing back the outcome of this review. However, the client and practitioner
never meet again and the child is left wondering what has happened. Could
it be that the practitioner saw the review as a way out of seeing the child
again? ‘Did I offend the practitioner without realising it?’ These and many
other questions may assail a child and this is why it is important to try to
bring the therapeutic process to a ‘natural’ conclusion.

For children who have experienced abrupt endings in their lives, abandonments
and broken relationships, this opportunity to have their therapist fully ‘right there
with them’ during a time of ‘good-bye’ can be very empowering and healing.
(Cochran et al., 2010: 153)

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Child-centred Therapy – Developing Practice II  77

In the context of child-centred therapy the practitioner is open to the client’s


experience and is able to accept the needs of that client. Reasons for a child
or young person wanting to finish therapy may, to the unwary practitioner,
seem as if the practitioner has failed in some way. The difficulty is that the
‘real’ reason for ending therapy may never be known to the practitioner and
trying to understand why sessions have been terminated can give rise to
therapist self-doubt. There are indeed times when therapy is brought
abruptly to an end as a consequence of a perceived shortcoming with the
therapeutic relationship, but hopefully this will be a rare occurrence.

Ending initiated by a client


Often when a child wishes to end therapy he/she will ask a parent to let me
know. At the next session I will say something along the lines of ‘your mum
contacted me the other day to let me know that you would like to stop meet-
ing and so this will be our last session today’. I will respect a child’s decision
without question and the session will be used as the client wishes. No spe-
cific ingredients are added to a final appointment: to do so might unhelp-
fully emphasise the ending and may even reflect the therapist’s personal
feelings about the conclusion. Young people in their middle to late teenage
years will generally communicate this decision directly, but some may
choose not to say so until the session is about to come to a close.
The reasons for a client appearing to suddenly decide to end the therapeu-
tic relationship can include the following:

•• A child or young person experiences a level of unconditionality and respect that is


unfamiliar and therefore to be avoided. For example, ‘Why are you (the practitioner)
giving me what my parents cannot provide?’
•• Similarly, a client might feel the practitioner is providing a relationship that an
estranged parent should be fulfilling. A child that values the therapeutic relationship
may find a gulf develops between that relationship and what he/she believes the
absent parent should be freely giving. When this occurs, a child may experience the
gap as too painful to cope with and therefore ends therapy in order to try to dimin-
ish the gap to a more manageable state.
•• A young person looks to a practitioner to provide answers to their questions about
relationships in which their focus for responsibility lies with somebody other than
themselves. A client who is listened to and whose feelings are acknowledged in
therapy may begin to recognise aspects of their responsibilities that they have previ-
ously tried to avoid: ‘How can I remain angry when I am in part responsible?’ For
some, this can be so difficult to face that they prefer instead to hold on to their anger
and thus terminate therapy.

Sometimes the client may want to blame the practitioner for not being good
enough – either because they cannot put their feelings into words or because
it might require the individual to ‘own’ their feelings. It can be unnerving for
an inexperienced therapist to be put in this position and it can have

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78  Person-centred Therapy with Children and Young People

unexpected consequences. A typical view might be that a child or young


person would prefer, for whatever personal reason, to see a female practi-
tioner or the other way round. After the start of therapy, it can sometimes be
hard not to take such a decision personally, but the client’s decision must be
respected even if it may seem unfair to the practitioner. In these circum-
stances, it is unacceptable for a practitioner to question a client’s decision
since it then becomes the therapist’s need to know rather than the client’s
wish to explain.

Occasionally, young clients may seek to bring about an ending but will avoid
expressing their feelings directly. After about three sessions, Ella (aged 11) began
to engage in activities I would describe as ambivalent and without an apparent
connecting ‘thread’. Moreover, she barely spoke to me. I sensed she was looking
for a reaction from me – that I would perhaps become angry (which I was not
going to do) and bring our sessions to a halt. She did this for two sessions and, as
if to emphasise her intentions, Ella would be bright and chatty when her mother
collected her at the session’s conclusion. It was my feeling that Ella wanted me
to give up on her and she could then blame me for letting her down. A subse-
quent session with Ella was cancelled because she told her mother she was tired.
The next appointment also failed to take place because Ella’s mother was unable
to persuade her to come. Her mother was profusely apologetic, but I was at ease
with the situation since it was Ella’s decision not to continue with therapy.
It would not be unreasonable for the reader to wonder why I did not express
my feelings sooner, but all I can say is that it seemed important to be patient and
allow Ella the space to reach her own decision. I believed this was important
since she had been seriously let down by adults in her early life and I was not
going to add to her growing list. I can also think of Matthew, then aged 12, who
had the experience of being let down by his father over a period of some four
years. His last two sessions of eight were characterised by him engaging in per-
sonal activities – reading and doing homework. Towards the end of the second
such session I told Matthew that it seemed as if he wanted to end therapy and if
this were the case then it would be fine by me. He totally ignored that comment
and once again it seemed he wanted me to make the decision. Following that
appointment I spoke to Matthew’s mother and without divulging information
from the session asked her if she could find out whether Matthew would like to
meet with me again. I let her know that I felt Matthew wanted me to give up on
him. Perhaps Matthew could bring himself to believe I was no different from his
father and, in this way, find a way of contextualising and diminishing the sadness
he felt in relation to his father. At the same time, it was important that Matthew
should have had a good enough experience of therapy to allow him to reconnect
with therapy in the future should he wish to do so.

Ending initiated by the therapist


In this section I consider the working arrangements that require practition-
ers to deliver, for example, short-term, focused therapy (i.e. therapy for a

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Child-centred Therapy – Developing Practice II  79

fixed number of sessions). It is not the purpose at this stage to comment on


the benefits or otherwise of such arrangements, but I do not feel it sits com-
fortably within the overall child-centred modality. Nevertheless some young
people of about 14 years and over may find that time-limited therapy is
facilitative for them, and it can be offered within a child-centred approach
provided the practitioner exercises care not to manage or constrain the cli-
ent’s process. I have found that young people can relate to, and work within,
a finite number of sessions, but it is also true that practitioners will be una-
ware of those occasions when a client elects not to introduce matters into the
time-limited relationship. Such issues may be of central concern to the client
but since the total number of sessions may not provide for full exploration,
a client may choose not to introduce the subject. Rigidity in the implementa-
tion of sessional time limits may, for some, invalidate essential aspects of the
therapeutic process.
Practitioners need to explain that the service will be contained within the
approved number of sessions. From the outset, the maximum time bound-
ary is made clear to the client although some policies provide for further
sessions once the initial tranche has been allocated. The extension of therapy
must be carefully explained at the appropriate review time and will vary
according to the needs of individual clients as well as the organisation’s
operational policies.
Practitioners working within prescribed funding or sessional limits might
helpfully commence each session with the number of the session. This infor-
mation will serve to remind clients of the fixed term as well as providing an
opportunity for them to pace their process if they feel the need to do so.
When the penultimate session is reached, it may be appropriate to state that
the next session will be the last. Young clients can then work towards a
planned ending in which they can guide themselves. Occasionally I have
found that upon reaching the last but one session, young people may ask for
the final session to be used in a specific manner. This might take the form of,
for instance, summarising their process during the course of therapy or
describing what they may be able to take forward in the coming weeks and
months.
In organisations that have policies allowing for extra sessions, the pro-
cedure for applying and obtaining authorisation for additional sessions
is likely to influence the point at which this matter may be appropriately
discussed with a young client. The matter may be raised either by the
client or practitioner. If, for example, by the fourth session of six it is evi-
dent to the practitioner that further sessions may be appropriate, the
matter can be discussed with the client and, if agreed, an application for
additional sessions can be made. Where authorisation may be subject to
a delay, it would be reasonable to make application in advance of the
sixth session to maintain continuity. Often when applying for additional
sessions, the purpose of these ‘extra’ sessions will need to be outlined in
the application following discussion and agreement on a form of words
agreed with the client.

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80  Person-centred Therapy with Children and Young People

Abrupt endings by others


On those occasions when the therapeutic relationship is ‘broken’, this can be
troublesome both for the client and practitioner. Rogers says that ‘if the con-
tact with the therapist is broken abruptly without a gradual substitution of
other sources of satisfaction, it may result in real harm to the child’ (1939:
352). There are circumstances in which therapy might end because the child
or young person appears not to be getting ‘better’, as adjudged by others.
When therapy is brought to an arbitrary end by a third party, it is as if the
relationship between client and practitioner is being severed without the
control of the primary participants.

I recall an intake session when a mother came to see me about her son (Jim) who
seemed to be behaving unreasonably at home and towards relatives following the
sudden departure of his father. At intake, it was evident Jim’s mother had her own
emotional difficulties and I therefore suggested it might be appropriate for her to
do some work with me. I reasoned that if she could find a better grounding for
herself, then she might be better able to provide the daily support her young son
required. She rejected this on the basis that Jim’s needs were more important than
her own. While I questioned this, I conceded the point and did some work with
Jim that, unsurprisingly, did not prove fruitful. I was contacted by a relative one
morning on the day of Jim’s next appointment and was informed that he would
not be coming to see me again because therapy ‘was not working’. With hind-
sight, I recognised that I should not have started to work with Jim, not because of
my professional sensitivities but purely because I felt he had been let down by
me. Rather than have therapy abandoned at an important stage in Jim’s process,
I believe I should not have allowed myself to be persuaded to meet with him in
the first place. I felt angry that I was being judged and wondered about Jim’s feel-
ings – how this decision might be affecting him. I never did find out, but so
powerful were my feelings that I needed to talk these through with my supervisor.
Thinking of my clients, and of Jim particularly, I am reminded of Axline’s belief
that the therapist ‘Does not terminate the contacts without considering the child’s
feelings and without informing him well in advance so that he will not feel
rejected’ (1947: 64).

Exercise

On a personal level, how comfortable might you be with relationship endings?


When might you find the end of a therapeutic relationship challenging and why?

Summary
This chapter describes some of the particular features of working with chil-
dren and young people. Transference is potentially facilitative in child-centred

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Child-centred Therapy – Developing Practice II  81

therapy and towards the end of the therapeutic relationship friendly interest
continues to be maintained (Rogers, 1939). As a concept, resilience is explored
within child-centred therapy. Resilience is a term more likely to be found in
psychodynamic theories, but it is also to be found in the way that some chil-
dren learn to cope with challenges in their lives. In child-centred therapy,
emphasis is placed upon an individual’s capacity to use their inner resource-
fulness to put in place constructs that will help them to generate some sense
of personal order. Play therapy is described in terms of both stages and catego-
ries of play. This is in the form of an overview to assist the developing practi-
tioner to recognise both the different ‘layers’ of play therapy.
Motivation for change among children and young people is an important
requirement in child-centred therapy. Without motivation there is little pros-
pect of therapeutic engagement or change, although at the onset of therapy
it is not necessary for clients to know what it is that they want to alter.
The therapist’s gender is explored and the scope for transference. For
instance, a male therapist is sometimes accorded the role of absent father.
The ending of therapeutic relationships is explored from different perspec-
tives, including that of the client and the practitioner, and abrupt endings
caused by others.

Suggested further reading

Boston, M. and Daws, D. (eds) (1977). The Child Psychotherapist and Problems of
Young People. London: Wildwood House.
Cochran, N. H., Nordling, J. W. and Cochran, J. L. (2010). Child-Centered Play Therapy.
New York: John Wiley & Sons.
Lanyado, M. and Horne, A. (1999). The Handbook of Child and Adolescent
Psychotherapy. London: Routledge.
Lazarus, R. S. (1993). From psychological stress to the emotions: a history of changing
outlooks. Annual Review of Psychology, 44: 1–21.
Tugade, M. M. and Fredrickson, B. L. (2004). Resilient individuals use positive emotions
to bounce back from negative emotional experiences. Journal of Personality and
Social Psychology, 86(2): 320–33.

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7
Child-centred Therapy – Children with
Particular Needs

Covered in this chapter:

•• Intellectual and physical disabilities


{{ Pre-therapy
{{ Focusing

•• Attachment disorders
•• Adoption
•• Childhood mental health disorders
•• Abuse: some definitions
•• Self-harm

Intellectual and physical disabilities


It is not unusual to meet children and young people who, at their first appoint-
ment, may come with a pre-assigned ‘label’ identifying them as ‘different’ from
the norm. The Disability Discrimination Act 1995 (as amended by the Special
Educational Needs and Disability Act 2001) required schools to ensure disabled
children were not disadvantaged compared to their peers. The Disability Dis-
crimination Act 2005 placed duties on all public authorities, including the pro-
motion of equality of opportunity between disabled people and others. The 1995
Act defines a disabled person as someone who has ‘a physical or mental impair-
ment which has a substantial and long-term adverse effect on his or her ability to
carry out normal day-to-day activities’. A 2005 report from the UK Cabinet
Office, Improving the Life Chances of Disabled People, suggests about 772,000 chil-
dren in the UK are disabled – this is equivalent to 7 per cent of all children.

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Child-centred Therapy – Children with Particular Needs  83

The Special Educational Needs (SEN) Code of Practice (DfES, 2001) (emerged
from the Education Act 1996) and identified a continuum of special needs and
required schools to make appropriate provision. One aspect of the legislation
was the preparation of statements of need for individual pupils that became
known as ‘statementing’, for which specific funding could be sought.
‘Statementing’ was regarded as a legitimate channel through which cash-
strapped schools could seek additional resources for named pupils. While it was
clearly never intended that pupils should become defined by their disability, this
seems to have become an unintended consequence. It is quite easy to see how
this situation evolved but the ‘label’ is anathema to the child-centred therapist.
The UK Government published a consultation paper, Support and Aspiration:
A New Approach to Special Educational Needs and Disability (Department for
Education, 2011a), which acknowledged that the existing system to support
children and young people often works against the wishes of families. The
paper cited delays in identifying needs, a culture of low expectations, limited
choices and fragmented services. It sets out proposals for a new, single assess-
ment process and education, health and care plan by 2014 and to introduce
greater independence in assessing children’s needs.
Practitioners in the child-centred modality will eschew attempts to ‘label’
children, even if, from the specialist medical perspective, it might be under-
standable. Therapists should continue to recognise that children or young
people who happen to have certain specified needs are individuals first and
foremost. To do otherwise is unacceptable.

Andrew comes to mind as I write this. He was born 40 years ago with spina bifida
and has endured a number of operations and substantial pain in his life so far. As
a child, Andrew was physically constrained by his condition, but he was also
regarded as an object of derision and pity by peers and adults alike. Although he
continues to struggle with pain and limitations of movement, Andrew works in a
school where, even now, attitudes towards children by others can trigger within
himself distressing recollections from his own childhood.

Colver (2008: 423–4), discussing ‘quality of life’ (QoL) in studies of disa-


bled children, commented: ‘It is surprising that reduction of impairment
is assumed by doctors and therapists to be the right aim – we never asked
parents what they thought, let alone the child, or the same child when
they became adult.’ Assessing QoL in children ‘is a challenge as children
have typically been regarded as unreliable respondents. Evidence is accu-
mulating that children can self-report QoL reliably if their emotional
development, cognitive ability and reading level are taken into account’.
He further mentions that ‘people with severe intellectual difficulties can-
not self-report, but estimating and improving their QoL is no less impor-
tant’. In a similar vein, Riley comments that ‘Children often rate their own
behaviour more positively than do their parents ... The symptom picture

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84  Person-centred Therapy with Children and Young People

can reverse when children have a chronic medical condition with parents
rating these children’s emotional state and health as worse than the chil-
dren (and adolescents) report for themselves, which tends to increase
parent-child concordance.’ (2004: 372).

Exercise

What are your feelings about the apparent ‘labelling’ of children and young
people? In what respects is formal diagnosis facilitative and when might it be
unhelpful?

Pre-therapy
Chapter 1 referred briefly to pre-therapy: Sanders (2007: 118) described it as
‘a way of being for special occasions’. Pre-therapy has evolved from Rogers’
concept of psychological contact, in which ‘all that is intended by this first
condition is to specify that the two people to some degree are in contact; that
each makes some perceived difference in the experiential field of the other’
(Rogers, 1957: 96).
Prouty (1998) outlines five ‘contact reflections’ in pre-therapy that routinely
feature in therapy where play and other non-verbal behaviour form the
foundation of communication between child and therapist. Pre-therapy
appears to have developed as a means of supporting severely traumatised
adult clients and others, such as elderly people who have dementia.
Although pre-therapy’s evolution seemed not to include play, it is my expe-
rience that aspects of pre-therapy are central to practice with a young child.
The following examples of Prouty’s ‘contact reflections’ have children and
young people very much in mind:

Situational reflections – The therapist, alongside the child’s actions, reflects any
realistic situation in the immediate environment. For example, ‘You have placed the
horse in the round box’. This helps the child get in touch with the momentary
concrete reality.
Facial reflections – These identify pre-expressively that which is being felt by a child.
For instance, I might reflect to a young client: ‘You seem tearful’. This may aid
affective contact with the child and provide ‘permission’ for sadness to be
acknowledged by that child.
Word-for-word reflections – These are attempts to develop communicative contact
with children who may be struggling to express their words. In therapy a young child
might say something like, ‘I joked you’, meaning I had been tricked into a specific
action by that child. Reflecting, ‘You joked me’ enables the child to experience
empathic reception by the therapist. In this way, word-for-word reflections facilitate
communicative contact with the client.

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Child-centred Therapy – Children with Particular Needs  85

Body reflections – These acknowledge that the physical presence of a child can itself
be expressive and may lead to verbal communication by that child or young person.
For instance, the seated client folds his/her arms. Two types of body reflection might
then follow: the first is I say, ‘Your arms are folded’ and the second is that I too fold
my arms. This can enable body reflections to become integrated within the embodied
experience.
Reiterated reflections – These embody the principle of reiteration and re-use of
previously successful reflections. If a particular reflection enables a child or young
person to communicate a response, then it can be appropriate to repeat that
reflection. For example, the therapist says ‘Last time you looked at that picture and
said….’, thus reflecting the client’s connection between the picture and the spoken
words even if it was unclear to the therapist. This reflection or reiteration might then
afford the client his/her personal meaning of the connection.

With children and young people who have intellectual difficulties I recog-
nise my way of being is not dissimilar to the principles of pre-therapy. For
instance, I (like Warner (2002b) below) may follow a literal, almost word-
for-word style of responding to young clients, allowing them to know I
understand their communication.

I was asked to do some work with Simon, a 10 year-old with autism. Simon’s
parents described him as demanding, as well as also loving and caring. Almost
from our first session, Simon was prone to frustration that he was not understood
or listened to by certain others. I found his play focused and repetitive. By accu-
rately and literally responding to Simon’s communications either through lan-
guage or play, it seemed he slowly came to recognise that it was possible for me
to both listen and understand his communications. Occasionally I might lack
precision in my reflections and when this occurred with Simon, he would just
look me in the eyes and say nothing. That was his way of admonishing me and
the subtlety of his expressions needed no clarification.

Warner (2002b: 464) describes being influenced by Prouty’s model of pre-


therapy, which ‘advocates very literal, concrete responses to clients who are
“contact-impaired” with self, world and other’. Warner has found this model
particularly helpful with clients whose conditions make empathic contact dif-
ficult. She goes on: ‘Luke is very much in contact with who he is, where he is,
and the fact that he and I are engaging in psychotherapy. But, the unusualness
of his way of processing experience and expressing himself verbally makes it
very difficult for him to feel that he is in communication or contact with others.’
It is to be hoped that further studies will serve to demonstrate that pre-
therapy has a legitimate place in child therapy as a viable approach to sup-
porting children and young people with either post-trauma or those with
intellectual disabilities. Nevertheless, I am sure there will be many difficul-
ties to address, not least the provision of funding for long-term therapy.

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86  Person-centred Therapy with Children and Young People

Focusing
Also outlined in Chapter 1, focusing was identified through research by
Dr Eugene Gendlin who was a philosophy student when he joined Rogers’
group at the University of Chicago Counseling Centre in 1953. His central
philosophical theme related to psychotherapy and ‘how our immediate
lived experiencing relates to the concepts we use to express and carry for-
ward that experiencing’ (Purton, 2004a: 45). Gendlin found it was possible to
predict which clients would be successful in therapy by noticing how well
they were able to listen to their inner, often unclear, experience. He noticed
some clients struggling to grasp what they were experiencing: that it seemed
to have both a physical and an emotional quality. As clients ‘focused’ on
their embodied being, giving it attention and respect, new insights emerged.
A client whose previously ‘blocked’ inner experiencing gradually became
accessible to that individual would also be able to establish a growing
respect for, and attentiveness to, their inner being.
The author Marta Stapert first became acquainted with focusing when she
was working in Holland as a child psychotherapist at a school for children with
intellectual and behavioural difficulties. She writes: ‘Through focusing, I learned
to reach my own inside place in a more profound way. As a result, I could be
even more open in my contact with children’ (Stapert and Verliefde, 2008: 2).
Through her accreditation as a focusing trainer and coordinator, Stapert increas-
ingly observed how natural a process focusing is for children and she saw that
it ‘deepened their connection to themselves, paving the way for growth and
change’. In 2008 Stapert and Verliefde published Focusing with Children: The Art
of Communicating with Children at School and at Home. Stapert says:

Just like adults, children can listen to their felt sense. They can describe where in
their body they experience things: fear, disappointment, the feeling of always
being on the side line, or of being bullied, the tension before a sleepover, the
excitement about a birthday party, or the pressure they feel from adults. (Stapert
and Verliefde, 2008: 17)

Through inner sensing, I feel that children and young people are able to gain
a better understanding of their predicament and to further develop their
individuality.
Focusing can be offered to people of all ages but, for me, practice and
experience are all-important to ensure its relevance to the individual. I will
give a couple of illustrations.

The first is a girl of 5 years (Carrie) whose mother identified changes in her
demeanour following her father’s departure from the family home to live with
another woman. Talking gently to Carrie, I acknowledged just how big a change
it was for her not to have her dad at home and what a struggle it must be. Carrie

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Child-centred Therapy – Children with Particular Needs  87

nodded slowly. I mentioned that her mum told me how hard it was for her to get
to sleep at night and I wondered if she could tell me about this. Carrie touched
her head and I commented that her mind was thinking a lot and perhaps this was
making it hard for her to sleep. Carrie told me that she sometimes had pains in
her head from thinking and I then asked her if she had any other sorts of pains.
Quietly and with some assurance, Carrie said that she sometimes had funny feel-
ings in her tummy as well that might make her feel a bit sick. Through this part
of our first session Carrie was able to make her own connections.

My second illustration relates to John, a 15 year old whose maternal grandfather


had recently died. The two had a close relationship and John would spend a lot of
time with his grandfather – a skilled carpenter. John had learned a great deal from
his grandfather but it was evident his sense of loss was considerable. John told me
he had been unable to express his feelings and could not understand why. As we
talked, John pointed to his chest and said that something seemed to be stopping
him from being sad. He went on to describe this ‘thing’ that felt like a tangle. As
John described this tangle I sensed different feelings within him were generating
some conflict. I mentioned how I felt and he then spoke about having to be strong
for his mother. It slowly emerged that John, worried about protecting his mother’s
feelings, tried hard to be stoical in her presence and could not reveal his feelings.
In essence, John had come to feel he must contain his emotions and try to deal with
them on his own. Becoming increasingly able to accept his feelings, John began to
openly express both his sadness and his enduring love for his grandfather.

Exercise

Thinking about the concepts of pre-therapy and focusing, consider how you
would utilise these principles in working with a 12 year-old boy who appears to
have mild symptoms of autism? Prior to the first session, identify your
preparedness for what you may encounter and then what elements of pre-therapy
and focusing could be appropriate, explaining why.

Attachment disorders
Chapter 3 introduced the theory of attachment developed by Bowlby and oth-
ers and explained its centrality to the early formation of significant relation-
ships both within and beyond the family. Attachment is a primal connection
between a child and parent (caregiver) that is profoundly influential in a child’s
emotional development. Conversely, attachment difficulties for children result
from negative experiences in regard to that connection. Without a secure con-
nection, a child is likely to struggle in expressing even simple emotions and in

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88  Person-centred Therapy with Children and Young People

establishing relationships. There is insufficient room in this chapter to do other


than describe some features of attachment disorders that may be encountered
in therapeutic practice. Howe et al. (1999: 35) point out that an insecure attach-
ment ‘is not in itself pathological, although children with an insecure attach-
ment are at increased development risk, but only a risk, of some maladaptive
and problem behaviours. Indeed, some personality characteristics associated
with insecure attachments may be functional in certain situations, producing
behaviours that may be valued and seen as appropriate’.
Döring (2008) notes how attachment theory emphasises the importance of
the reaction of the attachment figure in a predictable as well as contingent way.
‘This process is described as a mutual process, in which both sides have to
adjust to each other and in which it is important that the attachment figure
reacts flexibly, according to the needs of the child’ (Döring, 2008: 45). She goes
on to describe mothers of babies attached in an insecure-avoiding way who ‘do
not realise the needs of the baby and thus do not react when it cries’. In effect,
the mother’s communication to the baby is that it has no influence on the envi-
ronment, events are not predictable and negative feelings cannot be calmed. It
is in this way that babies are likely to suppress their negative expression of
affect and do not experience their feelings. Döring (2008: 45) states:

Mothers of babies attached in an insecure-ambivalent way do not react to the cry-


ing baby predictably. Sometimes they react as a caring mother; sometimes they
reinforce the negative affect. The emotional arousal of the baby disturbs both the
mother and the baby. Therefore, neither is able to regulate their feelings any more.

Children with attachment disorders or other attachment problems have dif-


ficulty connecting to others and looking after their own emotions. This results
in a lack of trust and self-worth, a fear of getting close to anyone, anger, and
a need to effect control, often arising through feelings of insecurity and lack
of emotional safety. Sometimes the circumstances that cause attachment
problems are unavoidable. For instance, the mother of a very young child is
suddenly admitted to hospital as the result of a medical emergency and has
an inpatient stay of several weeks. Another not altogether unusual set of cir-
cumstances involves a mother giving birth to a second child that requires
intensive support from birth. The older child might still be too young to know
what has happened and why, and it may seem to that child that no one cares.
As with many disorders, attachment issues lie on a spectrum of severity:
mild difficulties may be managed within a family on a self-help basis or even
elude recognition. Some children can be appropriately supported by ther-
apy. At the far end of the spectrum is Reactive Attachment Disorder (RAD),
featuring a markedly disturbed and developmentally inappropriate social
relatedness in most contexts beginning before the age of 5. Clients with RAD
require the input of skilled, resourceful and experienced practitioners whose
clinical workload can safely accommodate the often demanding and intense
requirements of such work.

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Child-centred Therapy – Children with Particular Needs  89

Exercise

You are asked to see a boy of 8 whose mother died when he was 2 years old. His
maternal uncle became his guardian after her death. He has become increasingly
concerned about his nephew’s emotional well-being over the last six months and
wonders if play therapy might be worth considering. The boy is expressing behaviours
resembling problems associated with attachment. With this background information,
consider the features you might come across and explain your reasoning for these
possible conditions.

Adoption
The legislation and guidance affecting adoption is complex and any practi-
tioner who chooses to offer therapeutic support to adopted children and
young people must be appropriately trained and registered either individu-
ally or with an agency. It is a specialist field of therapy and there are many
pitfalls.
It was only in the 1920s in the UK that adoption became legally recog-
nised. This followed centuries of informal adoption and fostering arrange-
ments. There were about 21,000 adoptions in 1975 and in 1995 the number
dropped to almost 5,800. Between 2002 and 2008 the annual number of
Adoption Orders entered in the Adopted Children Register in England and
Wales has varied between 4,600 and 5,600. At 31 March 2010, 64,400 children
were in the care of local authorities: 56 per cent were boys and 44 per cent
girls. A total of 3,400 unaccompanied asylum-seeking children were looked
after on 31 March 2010 and of these 89 per cent (or 3,000) were boys. A total
of 3,200 children were adopted from care during the year ending 31 March
2010, and the average age at adoption was 3 years 9 months.
About one year following completion of my initial Diploma training
there was an opportunity to undertake training in post-adoption counsel-
ling. At that time there was an emerging recognition of the need for local
authorities and adoption agencies to provide post-adoption counselling
services. Over the last ten years or so these services have continued to be
developed. A raft of legislation exists in relation to adoption: the Adoption
and Children Act 2002 includes measures to improve adoption support. The
Adoption Support Services Regulations (DfES, 2005) were enacted on 30
December 2005 and stipulated that counselling, advice and information
must extend to a wide range of people affected by adoption, including chil-
dren who may be adopted, their parents and guardians; persons wishing to
adopt a child; adopted persons, their parents, natural parents and former
guardians; children of adoptive parents (whether or not adopted); children
who are natural siblings of an adopted child; and related persons in relation
to adopted children.

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90  Person-centred Therapy with Children and Young People

The Regulations required private organisations and individuals offering


adoption support services to register with the Commission for Social Care
Inspection (subsequently becoming in England the Care Quality Commission).
Similar legislation was introduced in Wales, Scotland and Northern Ireland.
This legislative development meant that only counsellors and therapists
who were independently registered or a member of an approved adoption
agency could provide counselling support to people involved in or affected
by the adoption process.
From 1 April 2011, the Adoption Statutory Guidance (Department for
Education, 2011b) became effective, the primary legislative framework
being the Adoption and Children Act 2002 and the Children Act 1989. There
appeared to be a loss of momentum in the number of adoptions, the exist-
ence of regional variations, the presence of delays in the Family Justice
System and the lack of development of partnerships with the voluntary
sector and use of the Adoption Register by local authorities. In the foreword
to the Adoption Statutory Guidance updated in June 2012 (Amendment num-
ber 2) the responsible minister said: ‘We all know that children thrive and
are happiest when they live as part of a stable family.’ The minister goes on
to say, ‘It is therefore very disappointing that fewer children for whom
adoption is the right plan are currently being found new families.’
(Department for Education, 2012). The British Association for Adoption and
Fostering (BAAF) (2006: paragraph 1.1) states:

It is widely accepted that some children and young people in adoptive or foster
families find the closeness of relationships with parents/carers very difficult
indeed. The mutual intimacy of loving family relationships seems to be resisted
and/or rejected and this can show itself through behaviour and emotions that are
very hard to live with for all concerned.

Most adopted children will develop healthy attachments with their pri-
mary caregivers and encounter few difficulties in this area. Nevertheless
some adopted children and parents require significant and ongoing sup-
port. The processes that enable the ‘development of a loving and secure
home with carers that the child grows to know and trust and where the
child feels that they belong is still the best intervention for most children.
However, it may not in itself be enough to reverse the earlier damage for
some children and they and their carers may require specialist help’
(BAAF, 2006: paragraph 6.3).
Kelly (2008) describes working in a statutory setting and comments on the
challenges facing practitioners whose preference is to work from a person-
centred perspective in which it is necessary to deliver a service ‘bound by
the weight of a rigid structure’. Referring to the ‘adoption triangle’ – child,
adopter and birth parent – she says ‘relationships interweave in such a way
that it is unlikely one could work productively with a child without a
nuanced grasp of these intricacies’. She goes on: ‘The weight of adoption law
brings both license and restriction for a worker who is formulating plans for

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Child-centred Therapy – Children with Particular Needs  91

a child with the principle … that the welfare of the child is paramount’ (Kelly,
2008: 82). Many children are placed for adoption through a decision of the
courts that has determined that they cannot remain in their birth family. In
most cases, the child will not have developed secure attachment behaviours,
and conditions of worth have developed that are based on not being valued
for the unique person he or she is. Kelly points out that:

because court proceedings are often protracted, even an infant removed from
birth parents within the first 12 months of life may wait up to a further 12 months
before being placed for adoption. The quality of care in a foster home can be
variable and the child may or may not have been able to establish a secure
attachment to foster carers. (2008: 83)

Delays in the legal process are addressed in the Adoption Statutory Guid-
ance 2011. Kelly says that in the area of adoption, most practitioners
approach their work underpinned by the application of attachment theory.
While she acknowledges the continued relevance of attachment theory, Kelly
has also applied the principles of person-centred theory to adoption work.

Exercise

You are the parent of a child whom you adopted when she was just over 1 year
old. Circumstances have arisen that suggest your daughter (now aged 7) needs to
be given some information about her adoption. Consider how you might tackle
this issue.

Childhood mental health disorders


Generally speaking, mental health disorders in children and adolescents are
caused by biology, the environment, or a combination of these. Biological
factors include genetics, chemical imbalances and damage to the central
nervous system caused by, for example, a severe head injury. Many environ-
mental factors play an important part in the development of mental health
difficulties, including extreme anxiety or stress, violence and the loss of
people significant to that child or young person. This section seeks to do no
more than provide a brief introduction to some of the more common prob-
lems that affect children and young people. A 2004 survey conducted by the
UK’s Office for National Statistics (ONS) found that approximately 10 per
cent of children and young people aged 5–16 had a clinically diagnosed
mental disorder. Of that number, 4 per cent had an emotional disorder
(anxiety or depression) 6 per cent had a behavioural problem, 2 per cent a
hyperkinetic disorder (such as attention deficit hyperactivity disorder) and

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92  Person-centred Therapy with Children and Young People

1 per cent a less common disorder (such as autism, tics, eating disorders and
selective mutism). Some 2 per cent of children in the age group had more
than one type of disorder. Boys were more likely to have a mental disorder
than girls. Among 5–10 year olds, 10 per cent of boys and 5 per cent of girls
had a mental disorder. Among 11–16 year olds the proportions were 13 per
cent of boys and 10 per cent for girls. The 2004 survey revealed a similar pat-
tern to the 1999 UK survey (ONS, 2005).
Attention Deficit Hyperactivity Disorder (ADHD) is regarded as a neurobe-
havioural disorder that interferes with the person’s ability to remain focused
on the task and to exercise age-appropriate inhibition. ADHD has, in the
words of Timimi and Radcliffe (2005: 63), ‘reached epidemic proportions,
particularly amongst boys in North America’. Zito et al. (2000) states that
boys are 4–10 times more likely to receive the diagnosis of ADHD, and as a
result prescribed stimulants, than girls, with children as young as two being
diagnosed and prescribed stimulants in increasing numbers. In the UK, pre-
scriptions for stimulants increased from about 6,000 in 1994 to about 345,000
in the latter half of 2003 and the condition is estimated to affect about 5 per
cent of school-aged children, although in this country the disorder is
believed by many to be under-diagnosed (Sayal, 2007).
Numerous papers question the validity of ADHD as a diagnostic entity as
it cannot reliably be distinguished from other disorders. Schachter et al.
(2001) completed a meta-analysis of randomised controlled trials identifying
inconsistent short-term effects. Side-effects were frequent and problematic
and long-term effects beyond four weeks of treatment were not demon-
strated. Timimi and Radcliffe (2005: 64) ‘conceptualise ADHD as primarily a
culturally constructed entity’.
Anxiety is thought to be one of the most common childhood disorders.
Children and young people with moderate anxiety levels will at times feel
overloaded with worry. Outwardly, they may appear to be angry and there-
fore become identified as misbehaving or being unruly. In truth, what is
being expressed is a projection of their anxiety that may be almost entirely
unrelated to the matter that appears, to others, to be the subject of their
annoyance.
Anxiety disorders include phobias, the unrealistic and overwhelming fear of
objects or situations, generalised anxiety disorder, stemming not from a single
experience but from a more widespread state of worry, panic disorder, giving
rise to what is commonly known as ‘panic attacks’, obsessive-compulsive disorder,
which causes children and young people to become immersed in a pattern of
repeated thoughts and behaviours, and post traumatic stress disorder, which
causes a pattern of flashbacks and other symptoms in children and young
people who have witnessed or experienced a trauma such as abuse, violence
or natural disaster.
Depression operates on a scale from the mildest form to the severest, which
can put children and young people at risk of suicide. This disorder is marked
by changes in emotions (tearfulness and sadness), demotivation (losing

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Child-centred Therapy – Children with Particular Needs  93

interest in activities that promote self-care and physical well-being), dis-


turbed sleep patterns and changes in appetite (often unhealthy eating) and
thoughts (an inability to focus because the mind is preoccupied, which can
also occur with some anxiety disorders), feeling isolated and a strong sense
of hopelessness.
Bipolar disorder again is well known to exist on a spectrum of severity and
may be identified in children and young people who demonstrate exagger-
ated mood swings with perhaps periods of moderation between the ‘highs
and lows’. At the low end, children may experience severe depression and
at the high end, they appear to be ‘manic’, perhaps needing little sleep,
displaying an inability to sit still and showing unusually poor judgement
for their age.
Intellectual disorders make it hard for children and young people to
absorb or express information and typically might include dyspraxia and
dyslexia. Intellectual disorders can reveal problems with speech and writ-
ten language, coordination, attention or self-control. Such disorders are
usually assessed by educational psychologists and require the completion
of a series of tests. More obvious disorders may be relatively easy to iden-
tify but children and young people with mild affect, along with those who
have the ability to conceal their difficulties, may not be identified and thus
supported.
Conduct disorder causes children and young people to act out their feelings
or impulses in a destructive manner. Such problems may include lying, theft,
aggression, truancy from school, setting fires and vandalism. Although these
actions can be relatively minor at onset, they can become increasingly seri-
ous. It is considered that, generally, children and young people with conduct
disorder have little concern for others and violate the rights of others and the
rules of society in general.
Eating disorders can be life-threatening and include anorexia nervosa,
bulimia nervosa and binge/comfort eating. Anorexia is associated with chil-
dren and adolescents whose focus is centred upon a fear of gaining weight
and who are invariably unable to recognise that they are in fact underweight.
This condition is generally affects more girls than boys but there may be a
tendency to overlook this condition in boys. Bulimia compels young people
to eat and then rid their bodies of food by vomiting. Bulimia is defined as fear
of fatness, while maintaining normal appearance and normal weight. In addi-
tion to the cycle of bingeing and vomiting, many female sufferers have
irregular periods, use laxatives excessively, have a feeling of lack of control
over their eating behaviour and are persistently overly concerned with body
shape and weight. The cycle of bingeing and vomiting can become well estab-
lished and difficult to break. Anorexia and bulimia can be associated with
excessive exercise, self-harming (see below) as well as suicidal and psychotic
behaviour. Comfort eating occurs when children and young people use food
to give them a feeling of well-being (during consumption) and may then be
associated with self-loathing (following consumption).

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94  Person-centred Therapy with Children and Young People

Autistic disorder is a neurological disorder – children are born with it and


the condition affects the way the brain develops. It tends not to be officially
diagnosed until children show clear outward signs at around the age of 3.
Again, autism is a spectrum disorder and at any point along this scale chil-
dren with this condition are prone to exhibit problems with social commu-
nications, such as lack of eye contact, difficulty carrying on a conversation
and taking another person’s perspective. Early intervention and appropriate
therapeutic treatment can enable some children with autism to learn and
function productively but there is no ‘cure’ for the disorder.
Aspberger Syndrome (AS) is a pervasive developmental disorder, the most
distinguishing symptom being a child’s obsessive interest in a single object
or topic to the exclusion of any other. Children with AS are keen to know
everything possible about their topic of interest and their conversations with
others will be about little else. They may therefore tend to become isolated
because of their poor social skills and narrow interests. Other characteristics
may include problems with non-verbal communication and uncoordinated
motor movements.

Exercise

Selecting one of the conditions described in this section, examine it in more


detail in order to gain a good understanding of the key features and how child-
centred therapy might be beneficial.

Abuse: some definitions


Child abuse is any form of physical, and emotional or sexual mistreatment
or lack of care leading to injury or harm. It commonly occurs within a rela-
tionship of trust or responsibility and is an abuse of power or breach of trust.
Abuse can happen to a child regardless of age, gender, race or ability. Abus-
ers can be adults (male or female) and other young people, the latter usually
being associated with bullying and other forms of intimidation (see Figures
7.1 and 7.2), and are usually known to the child and family. Four main types
of child abuse include: physical abuse, sexual abuse, emotional abuse and
neglect. Some children and young people with a disability are mentally or
physically more vulnerable than others. This can make it easier for abusers
to exploit them and they may also find it more difficult to recognise and
report abuse, and to be believed.
Physical abuse is described by the Department for Children, Schools and
Families (DCSF) (2010: 38, paragraph 1.33) as involving ‘hitting, shaking,
throwing, poisoning, burning or scalding, drowning, suffocating, or other-
wise causing physical harm to a child. Physical harm may also be caused
when a parent or carer fabricates the symptoms of, or deliberately induces,

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Child-centred Therapy – Children with Particular Needs  95

illness in a child.’ Creighton (2002) states that 8,000 children were registered
for physical abuse in England during the year ending 31 March 2001. Infants
and boys were more likely to be physically abused than older children and
girls. She also records that physically abused children had been shown to
suffer adverse physical, mental and social development.
Sexual abuse involves ‘persuading or forcing a child to take part in sexual
activities, or encouraging a child to behave in sexually inappropriate ways’
(National Society for the Protection of Cruelty to Children, 2012). The
activities may involve physical contact, including penetrative or non-
penetrative acts, and also non-contact activities, such as involving chil-
dren in looking at, or participating in the production of, sexual images,
watching sexual activities or encouraging children to behave in sexually
inappropriate ways.
Emotional abuse is defined by the NSPCC as the ‘severe and persistent ill-
treatment which adversely affects a child’s emotional health and development’
(2012). Children might be told that they are worthless or unloved, inadequate,
or valued only in so far as they meet the needs of another person. It may feature
age or developmentally inappropriate expectations being imposed on children,
exploitation or corruption and cause children to feel frightened or in danger.
Some level of emotional abuse is involved in all types of child ill-treatment
although it may occur alone. Different categories of emotional abuse were
described by Garbarino et al. (1986). These are described below:

•• Rejection – Sometimes described as one of the most insidious forms of emotional


abuse, rejection occurs when a parent or carer withholds affection or refuses to
acknowledge the child’s presence or accomplishments. A rejecting adult is
emotionally detached and does not value a child’s thoughts and feelings. I can think
of one young teenager who was told by her mother that she was a mistake and
should never have been born. Baumeister et al. (2002) describes a study that
randomly assigned rejection experiences to students. It found that rejection could
dramatically reduce a person’s IQ and their ability to reason, while at the same time
increasing their aggression levels.
•• Ignoring – This is failing to give a response to or interact with a child or young
person. This might take the form of failing to engage a child in day-to-day activities,
being inattentive to significant events in a child’s life, showing a lack of attention to
schooling and refusing to discuss a young person’s activities and interests.
•• Isolation – This occurs when a parent or carer restricts contact with others,
preventing a child from forming relationships. This can also apply to normal family
interactions that are restricted: a child may be required to stay in his/her room for
extended periods. Kairys and Johnson (2002) state that isolated emotional child
abuse has the lowest rate and substantiation of any of the types of emotional abuse.
•• Terrorising – This includes witnessing family violence, whether physical or verbal,
and threatening a child with physical harm and/or placing a child in dangerous
situations. Terrorising occurs not only when a child observes but also hears violence
or knows that violence is taking place in the home. Other ways in which a child
might feel terrorised include extreme responses to his/her behaviour by a significant
family member, threatening to destroy a favourite object, displaying inconsistent
emotions and threatening abandonment (see Figures 7.1 and 7.2 (i) and (ii)).

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96  Person-centred Therapy with Children and Young People

•• Corrupting – This concerns the encouragement of anti-social or delinquent


behaviour, including permitting young children to consume alcohol, showing them
pornographic images, or exposing children to acts of cruelty carried out by others.
Corruption also arises when a child or young person is encouraged to do things that
are illegal or harmful to themselves, such as rewarding bullying behaviour,
harassment and encouraging violence in sporting activities.

Figure 7.1  Being Bullied – abuse that can blight a young life

Figures 7.2(i) and (ii)  Being Shouted At – by someone with power and
control can have long term adverse emotional
consequences

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Child-centred Therapy – Children with Particular Needs  97

Exploitation – This is abusive when children are used for advantage or profit,
such as involving them in stealing and drug dealing, especially when young
children become a ‘cover’ for the illicit activities of others. Exploitation also
occurs when a child or young person is assigned responsibilities far greater
than a person of that age should reasonably expect to handle. This might
include blaming a child or young person for the misbehaviour of younger
siblings and expecting a teenager to provide levels of unreasonable financial
support to the family.

Neglect is defined in child protection guidance, Working Together to Safeguard


Children (DCSF, 2010: 39) as:

The persistent failure to meet a child’s basic physical and/or psychological needs
(which is) likely to result in the serious impairment of the child’s health or devel-
opment. Neglect may occur during pregnancy as a result of maternal substance
abuse. Once a child is born, neglect may involve a parent or carer failing to
provide adequate food, clothing and shelter, protection from physical and emo-
tional harm, inadequate supervision and inadequate access to appropriate medi-
cal care or treatment. It may also include neglect of, or unresponsiveness to, a
child’s basic emotional needs.

Exercise

Parents divorce and their two children spend most of their time with their mother.
Their father is asking to see his children but the children have been told by their
mother not to contact him. What type(s) of abuse, if any, do you think might be
relevant in this case?

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98  Person-centred Therapy with Children and Young People

Self-harm
Self-harm is described as deliberately hurting oneself without the intent to
commit suicide. Most people feel ashamed of what they are doing and try to
conceal it from adults and peers. It is usually done in private and often goes
undetected or is explained as being accidental. Those who self-harm come
from a broad spectrum of backgrounds: they range from being perfectionists
to school ‘misfits’. It is thought that those who self-harm may feel less confi-
dent than their peers or appear to lack the necessary social skills for their age
range. Children and adolescents who hurt themselves are generally unable
to verbally express their feelings and needs.
Individuals may inflict pain upon themselves to reduce physical or emo-
tional tension and to relieve emotional pain caused by feeling worthless,
anxious and so on. Feeling physical pain can demonstrate that they are
‘alive’, thereby fending off emotional detachment. It can also enable indi-
viduals to regain control by converting emotional pain into physical pain
since it may appear easier to manage as physical pain. Finally, children and
young people can inflict pain on themselves as a means of self-punishment
for real or perceived wrongdoings, such as being bad, stupid or guilty, and
when words or outward actions are perceived to be unacceptable or when
the emotional pain is too severe to put into words.
Babiker and Arnold (1997) suggest that when someone self-harms, for
example, it seems likely that they have found a behaviour that provides a
singularly powerful solution to the problem of expressing or, coping with
overwhelming feelings. According to Baker and Newnes (2005: 33): ‘they
may also, at least at the time, be prepared to accept the consequences, such
as loss of blood, permanent scarring and even alienation from others’.
Seeking to control the behaviour of people who self-harm without their rec-
ognition of the need to take personal responsibility can create, according to
Johnstone (1997: 425), ‘the very circumstances that are likely to have led to
the need to self injure’.
Hawton et al. (2002) published a paper on self-harm in adolescents in
England using an anonymous self-report survey. More than 6,020 pupils
aged 15 and 16 participated in this cross-sectional survey across 41 schools
in England. The results of this survey revealed that in the previous year 6.9
per cent of participants reported an act of self-harm that met the study crite-
ria. Self-harm was found to be more common in females than it was in males
(11.2 versus 3.2 per cent). The paper states that self-harm ‘is common in
adolescents, especially females, with an estimated 25,000 presentations to
general hospitals annually in England and Wales’ (Hawton et al. 2002: 1027).
Only 12.6 per cent of survey participants presented to hospital. In females,
the factors leading to self-harm included recent self-harm by friends, self-
harm by family members, drug misuse, depression, anxiety, impulsivity, and
low self-esteem. In males, the factors were suicidal behaviour in friends and
family members, drug use, and low self-esteem.

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Child-centred Therapy – Children with Particular Needs  99

The Social Care Institute for Excellence (SCIE), in a Research Briefing Paper
published in August 2005, stated that while four times as many girls as boys
self-harm up to age 16, this ratio reduces to twice as many among 18–19 year
olds. According to the SCIE, the following are the principal factors associated
with increased risk of self-harm among children and adolescents: mental health
or behavioural issues, such as depression, severe anxiety and impulsivity; a
history of self-harm; experience of an abusive home life; poor communication
with parents; living in care or secure institutions.

Exercise

You are aged 14 and have been feeling stressed for over six months. Over the last
few weeks you have been cutting your arm to relieve the pressure. Despite trying
to hide the injuries, your parents find out and accuse you of being manipulative
and attention seeking. Describe in detail your reactions to this accusation. Might
you ask for help or would you try to ignore it?

Summary
This chapter describes a child-centred approach to working therapeutically
with children and young people who may present with a range of ‘prob-
lems’. Therapists need to develop a relationship with individuals who also
happen to have a disability or problem, and not the other way round.
Focusing and pre-therapy are both considered to be modalities within the
person-centred approach and each has a place in working with younger clients.
Attachment problems generate difficulty for children and can compromise a
child’s ability to ‘connect’ to others and also pose problems in managing their own
emotions. Unavoidable circumstances can contribute to attachment problems.
Adoption procedures in the UK are the subject of comprehensive and com-
plex regulation. Implementation of Adoption Statutory Guidance from 1 April
2011 (Department for Education, 2011b) seeks to address a number of issues,
including the need to provide a more child-centred service.
Mental health disorders in children and adolescents are caused by biol-
ogy, the environment, or a combination of these. Some of the more familiar
problems affecting children and young people are briefly described.
Child abuse is defined by the NSPCC (2007) as ‘behaviour that causes
significant harm to a child. It also includes when someone knowingly fails
to prevent serious harm to a child.’
Self-harm is recognised to be a growing problem in the UK and in mid-
teenage years is thought to be four times more prevalent among girls than
boys, with the gap diminishing in later teenage years. Such individuals come
from a broad spectrum of backgrounds.

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100  Person-centred Therapy with Children and Young People

Suggested further reading

Cooper, M., O’Hara, M., Schmid, P. F. and Wyatt, G. (eds) (2007). The Handbook of
Person-Centred Psychotherapy and Counselling. Basingstoke: Palgrave Macmillan.
Department for Education (2011). Adoption Statutory Guidance: The Adoption and
Children Act 2002 (1st revision). London: Department for Education.
Hawton, K., Rodham, K., Evans, E. and Weatherall, R. (2002). Deliberate self-harm
in adolescents: self-report survey in schools in England. British Medical Journal,
325: 1207.
Newnes, C. and Radcliffe, N. (eds) (2005). Making and Breaking Children’s Lives. Ross-
on-Wye: PCCS Books.
Stapert, M. and Verliefde, E. (2008). Focusing with Children: The Art of Communicating
with Children at School and at Home. Ross-on-Wye: PCCS Books.

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8
Directive and Non-directive Therapy

Covered in this chapter:

•• Introduction
•• The principles of non-directive therapy
•• Offering direction within the child-centred approach

Introduction
Central to the person-centred tradition is the principle of non-directivity by
the practitioner towards the client. Rogers (1939) listed factors he found
important in maintaining a good relationship with the parents of a ‘problem’
child. A key to success in working with children was described as ‘the
essence of non-interference’. Rogers (1980) speaks of the person-centred
approach and how this theme became clarified through experience, interac-
tion with others and research.
Rogers, describing his shifting views, says: ‘This transition is well cap-
tured in my book, Clinical Treatment of the Problem Child, written in 1937–1938,
in which I devote a long chapter to relationship therapy, though the rest of
the book is largely a diagnostic-prescriptive approach’ (Rogers, 1980: 37).
Soon afterwards, while working at Ohio State University, Rogers began
recording therapeutic interviews and these helped him ‘to focus my interest
on the effects of different responses in the interview. This led to a heavy
emphasis on technique – the so-called nondirective technique’ (p. 37).
Focusing on the therapist’s responses had, in Rogers’ words, ‘appalling
consequences’. He describes the approach becoming known as a ‘technique’.
‘Non-directive therapy’, it was said, ‘is the technique of reflecting the client’s
feelings’. An ‘even worse caricature was simply that “in non-directive ther-
apy you repeat the last words the client has said”’. Rogers declared himself

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102  Person-centred Therapy with Children and Young People

‘shocked by these complete distortions of our approach’ (p. 139). Purton


(2004a: 61) comments that ‘non-directivity’ can suggest that there is no direc-
tion in person-centred therapy whereas for Rogers there is a direction, but it
is the client’s direction (Cain, 1989: 125). It is also said that non-directivity
‘suggests that the therapist wishes to have no influence on the client. Yet that
is not only undesirable; it is impossible’ (Purton (2004a: 61).
I find that today – as with Rogers’ own experiences – person-centred prac-
titioners continue to be faced with demands for a results-driven practice or
are required to justify their seemingly passive approach to therapy.

When I was asked at a formal social services meeting about my objectives in


relation to therapy I was providing to Frankie, a 14-year-old client, I remarked
that the therapeutic relationship was enabling her to find the means to feel lis-
tened to and understood in a way that allowed Frankie to find the means to
change aspects of her life and relationships. Clearly, the person who asked the
question was not impressed for when Frankie later joined the meeting, the same
individual asked her what she got from seeing me. Frankie described how I
helped her to work through difficult problems and how, at the end of each ses-
sion, she felt the knot inside her unwind.

It may be tempting for the person-centred therapist to describe the approach


in terms that may be deemed acceptable to different audiences in order to please
others. In this same way children may often be required to conform to and meet
the expectations of those in a position of influence. Invariably, this may alter or
in other ways subjugate the veracity of their feelings. As a therapist, I feel I need
to be steadfast in my practice – that I honour my feelings and uphold my respon-
sibility to my clients – with a gentle authority rather than fanatical fervour!
Another area of comment concerns questions asked by the therapist. It
may be thought of as entirely child-centred not to ask a client questions, but
I believe this to be an approach that can be unhelpful in working with chil-
dren and young people. At the other end of the scale, there is the practitioner
who, with the best of intentions, asks too many questions. According to
Geldard and Geldard (2008: 112):

Many children, in response to such pressure for answers, become very adept at
producing what they consider to be the ‘right’ answers. These are answers which
the child thinks will satisfy the questioner. They are not necessarily what the child
believes to be true and they may not fit with the child’s experience.

The terms ‘directive’ and ‘non-directive’ have become a source of conflict


and confusion even within the person-centred modality. This chapter seeks
an accommodation for these terms and demonstrate that in child-centred
therapy, they need not be opposing tendencies: rather, they can be comple-
mentary and mutually supportive in assisting a child or young person to
explore the possibilities that can, in time, become increasingly available to
them. Child-centred practitioners support clients in their personal

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Directive and Non-directive Therapy  103

exploration while accepting that – often without any certainty – given the
appropriate conditions for growth, children and young people will find a
pathway appropriate for their present circumstances. It may be hard for
some adults to believe children and teenagers are able to find a way that
feels right for them, but it is inherent to child-centred therapy that such an
approach is offered with genuineness and confidence.

The principles of non-directive therapy


In Chapter 2 I referred to Moon (2002) and her description of working with
child clients as being consistent with the principle of non-directive, client-
centred psychotherapy to which she aspires in her work with adults. Moon
mentions that Rogers’ approach ‘provides me a way to work in accordance
with my wish to honor the client’s self-direction’ (Moon, 2002: 485). The child-
centred practitioner respects each client for the uniqueness he/she embodies.
In working non-directively with children and young people, I am able to
accompany each client in a manner that embraces my child-centred view of
Rogers’ six conditions model (see Chapter 2). I have a deep respect for my
clients, irrespective of their age, and endeavour equally to apply these condi-
tions at all times. Nevertheless, in my constant effort to be a better practitioner,
I must always acknowledge, through careful reflection, my own frailties.
Grant (1990) claims the principle of non-directivity in person-centred
therapy can be justified instrumentally because it helps the client, or morally
in terms of respect for the client. He emphasises: ‘liberation that can come
from client-centred therapy is accomplished by respecting clients as autono-
mous beings, not by making them autonomous beings’ (Grant, 1990: 374). I
feel that this statement is no less true of child-centred therapy in which the
practitioner does not attempt to effect change in the child or young person,
but provides the therapeutic conditions believing them to be expressions of
respect and acceptance that may be helpful to the client. Grant says, ‘Princi-
pled non-directedness is an attitude, not a set of behaviours’ (p. 373).
I may use the term ‘accompany’ – being alongside my client – that is, neither
leading from the front nor prompting from the rear. Burstow (1987) identifies
areas in which the therapist and client are not necessarily equal or unequal,
but the likelihood is that the therapist will have more power. An obvious
example of possible inequality in child-centred therapy is the adult in relation
to the child or young person. Society maintains conditions, such as the legal
system, that enshrine in law the responsibility of adults for the well-being of
children in their care, however temporarily. In order successfully to offer the
appropriate conditions to younger clients, I set aside the usual societal norms
so I endeavour to be equal in the therapeutic relationship. That does not
absolve me in any way from my legal and professional duty of care to my
clients, but those responsibilities do not need to overshadow the therapeutic
relationship. The single ‘rule’ I mention to children at our first appointment
(see Chapter 11) is that ‘I look after you and you look after me’. This statement of
equality is reflected by Axline (1947: 131), who says:

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104  Person-centred Therapy with Children and Young People

The therapeutic relationship, to be a success, must be built around a genuine respect


that both the child and therapist have for one another. The child needs a certain
amount of control. He is not entirely self-sufficient. The control that is the outgrowth
of mutual respect seems to be far more conducive of good mental attitudes than any
other method of control. The therapy experience is a growth experience.

Larner (1999) stresses the ethical challenge of working within a relation-


ship of unequals. He states that integral to the ethics needed is a position
of humility by the therapist: ‘that therapists can be powerful, but sacrifice
themselves for the sake of the other, allows the power of the other to
emerge’ (Larner, 1999: 41). The term ‘sacrifice’ does not imply that the
practitioner becomes peripheral to the therapeutic process – far from it. It
does mean, however, that the authority of the therapist is put to one side
so that an equal relationship can be established and maintained. Larner
(1999: 48) comments further: ‘The conscious movement of the therapist
towards the other as an ethical stance allows the true dialogue of une-
quals, in which both therapist and client are powerful and non-powerful’.
Proctor (2002: 38) confirms the commitment of the therapist not to use
‘power-over’ the client and to affirm both the therapist’s and the client’s
sense of ‘power-from-within’.
Some might consider that the use of observation methods is a form of
non-directivity in child-centred therapy simply because the counsellor is
not directing the child. However, I do not consider this to be child-centred
since it does not fulfil the necessary conditions defined in Chapter 2.
Observation is utilised to study a child’s actions and behaviours, but the
practitioner is not in relationship with the client: rather, the opposite is
true. An adult client recently told me of an observation carried out by a
court officer in relation to her 3 year-old son. In a formal report the officer
identified apparent obsessive behaviour since the child was lining up
objects. What my client told me was that, at his nursery school, her son was
learning to count using objects and it is, of course, easier to count when
items are in a row than in a heap. As Geldard and Geldard (2008: 99) point
out: ‘While observing the child, we monitor our own behaviour to ensure
that we are refraining from making judgements and interpretations about
the child’s presentation.’
Stumm (2002: 117) states, ‘provided that the basic attitudes translate into
fulfilment of the necessary conditions in such a way that they are actually
experienced, and that no techniques are forced on the client (principle of
‘non-directiveness’) there are no limits to the spectrum of treatment practice’.
Applying expert-orientated intervention to child-centred therapy – in other
words, the application of therapist-prescribed techniques – compromises the
child’s movement towards self-actualisation and therefore the relationship
ceases to be child-centred.
Brodley (2002: 184) states that ‘Nondirective following also expresses the
therapist’s unconditional positive regard for the client’, and again, ‘the therapist
is not gathering information about the client’s phenomenology in order to make
effective interpretations, but engaging in understanding for its own value. The

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Directive and Non-directive Therapy  105

ultimate purpose of this empathic understanding is the therapeutic benefit that


is found to be inherent in the understanding interaction and relationship’.
On the therapy session, Geldard and Geldard (2008: 12) state: ‘Structure
gives the child a sense of security and predictability during therapy sessions.
It also allows the counsellor to remind the child that indulging in repetitive,
non-purposeful activity will reduce the amount of time for constructive work.’
In contrast to this prescriptive statement, Landreth (2001) remarks on the need
for some children to engage in repetitive play (Chapter 6) to enable them to
explore difficult traumatising events such as sexual abuse. Geldard and Geldard
demonstrate a thorough knowledge of their integrative approach to child therapy
and therefore utilise different models according to needs assessed by the counsellor.
Their approach does not claim to be child-centred when they say:

For example, Client-Centred Counselling is particularly helpful in enabling a


child to join and tell their story, Gestalt Therapy is very useful for raising a child’s
awareness and helping the child to get in touch with strong emotions, Narrative
Therapy is eminently suitable for helping a child to change their view of them-
selves, Cognitive Behaviour Therapy and Behaviour Therapy are recognized as
being most appropriate for producing changes in a child’s thinking and behav-
iours. (Geldard and Geldard, 2008: 65)

It is a challenge for the child-centred practitioner to offer a non-directive


relationship that is both respectful and appropriate to the age and experience
of the individual client. Moreover, children and young people are no differ-
ent from adults in needing to feel understood and accepted by the therapist.
As Brodley (2002: 185) puts it:

The goal is accurate empathic understanding of the client, and the client deter-
mines what is accurate. The forms of the therapist’s communication, consequently,
depend in part upon a client’s characteristics – the client’s vocabulary, style of
speech, flow – that become apparent as the therapist interacts with the client.

When applied to child-centred practice, practitioners need accurately to


communicate through play where language may not be spoken, where feel-
ings may be expressed through the use of materials, body language and
demonstrable behaviour, as well as spoken communication in the manner of
the adult therapeutic process. The breadth of skill and experience needed to
support the overall age range of children and young people suggests that it
is not unusual for practitioners to ‘specialise’ within a given age group.

Exercise

Describe in your own words what you understand by the term ‘non-directive’ in
the context of child-centred therapy. Under what circumstances might you feel
challenged to maintain non-directivity?

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106  Person-centred Therapy with Children and Young People

Offering direction within the child-centred approach


I am aware that there are occasions in my work with children and young
people when it is appropriate to offer direction. At one time I judged any
aspect of my client relationship that lay beyond the centrality of ‘non-direc-
tion’ to be illicit within the context of the classical person-centred model.
Although I could validate the cautious application of direction, I felt this
would be difficult to justify within the person-centred community. As I now
come to write this chapter, I recognise that ‘direction’ exists in a spectrum of
shade, form and nuance.
The essence of my practice is indeed non-directive and I have concluded that
in order to be authentic in describing child-centred practice, it is important I
can demonstrate that, even when I may harbour doubts about my non-direc-
tive ‘credentials’, such reservations serve to underline my personal need to
continue to strive for improvement through reflection and self-questioning.
Directive therapy has variously been defined as the therapist leading the
therapeutic process, a method of treatment by which the therapist, assuming
complete understanding of the client’s needs, endeavours to change the cli-
ent’s attitudes, behaviour or mode of living. Other descriptions place the
therapist overtly in charge, prescribing treatment for solving specific problems
and addressing specific target symptoms. The person-centred practitioner will
find phrases such as ‘overcoming specific symptoms’, using the therapeutic
relationship as the means to ‘persuade overtly and powerfully’, using ‘tech-
niques to break down the client’s defences’ and ‘directing a client according to
the therapist’s own value system’ as manifestly not person-centred. The
underlying emphasis of these terms infers power in the therapeutic relation-
ship centred upon the practitioner not the client. Moreover, the language
implies that clients forego their need to effect personal control of their process
in the belief that the directive therapist ‘knows best’ and that, provided the
client does what he or she is told, improvement can be assured.
Geldard and Geldard (2008: 101) comment:

If a child can initiate play, then the counsellor does not need to be involved in
the play except when wanting to influence it. The counsellor is then free to
withdraw and observe the development of themes that arise in the content of the
play. Additionally, the counsellor can observe the quality of the play and can
notice whether the play is goal directed and following an understandable
sequence and whether play materials are being used appropriately.

Reading this extract from a purely child-centred perspective, those phrases


shown in italics, feel incongruent.
Working with children and young people can present the inexperienced
practitioner with the uncertainty of how to ‘be’ in the relationship. The child-
centred practitioner will be older than the client and might therefore be
assumed to be more knowledgeable in life experience. After all, young clients

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Directive and Non-directive Therapy  107

are familiar with adults exercising power and control – within the family, at
school and in society at large – and might therefore anticipate that the thera-
peutic relationship will present similar conditions. From the outset, practition-
ers seek to offer an equal relationship with consistency and assuredness.
The person-centred approach has therefore tended implicitly to regard
directive attitudes and practices to be outside the field of this approach. In
recent years, there has been a movement towards the view that directivity
(in an appropriate form) can have a place in person-centred therapy – such
as in focusing-orientated therapy – that seeks to assist clients to relate to
their personal experiencing within the overall relationship of trust and
safety that the core conditions provide.
What do I mean by offering ‘direction’? Child-centred therapy needs to
be able effectively to appropriately reflect the range of existing experi-
ence, personal understanding and stage of emotional development of
individuals. These are embodied in the uniqueness of each child’s and
young person’s life experience. Moreover, within the child-centred age
group some of the most significant transitions will occur, leading from
total reliance upon others for care towards a growing independence.

As I think about offering direction, my thoughts alight on an experience with


Harry, who was aged 10 when I met him. He came to his appointment one day
and, being quite fidgety (unusually for him), I expressed how I felt: ‘You seem to
be a little on edge today’. Harry quickly responded, ‘That’s because I’m so frus-
trated’. I wondered aloud how frustrated felt and said, ‘It feels like a volcano that
is about to erupt’. Harry looked at me for a moment and then said, ‘That’s exactly
it: I’m a volcano’. I remarked that if I drew an erupting volcano, perhaps he could
write the words that best described how he felt. Harry readily agreed and having
drawn the volcano, he wrote just one word: RELIEF. I was perplexed but simply
said, ‘When your volcano erupts, you feel relief’. Harry nodded his agreement
and said ‘Yeah’. It was only as I later reflected that, for Harry, he would feel ten-
sion building within him and once it reached its peak, he would become angry
and lash out. Harry taught me that anxiety has the capacity to build up until it
has nowhere else to go other than outwards. When that storage capacity has been
reached (contained within the individual) then any excess will become projected
(externalised).

Figure 8.1 illustrates this metaphor. This means that even a minor occurrence can
tip the balance and result in an overreaction, as perceived by others. For Harry,
relief came when he erupted, expressing his frustration at his presenting circum-
stances that then reduced his anxiety to a more manageable level. When I next
met Harry, I said that I had been reflecting on his volcano and that I thought I
now understood what he had been describing. Harry concurred with my reflec-
tions and seemed satisfied that I understood correctly.

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108  Person-centred Therapy with Children and Young People

Figure 8.1  T
 he Erupting Volcano – can provide for a release of negative
internalised energy although its consequences may be felt by all
around

Mearns and Thorne (2000) discuss various forms of suggestion and selec-
tive reinforcement of client responses. They remark:

The importance of directivity is not in what the counsellor does but in what the
client experiences. Whether my behaviour as a therapist looks directive or non-
directive to my peers is entirely irrelevant – what matters are the functions of my
behaviour. The question that should be asked is not ‘Is the therapist behaving
directively?’ but ‘Is the client being directed?’ (Mearns and Thorne, 2000: 191)

It is incumbent upon the practitioner to accurately assimilate all the factors


that embody the individuality of each client. Children do not suddenly
change from play as their preferred form of communication to the spoken
word form. Like many aspects of the human condition, it is a transition that
will ebb and flow. In their teenage years particularly, young people will be
exploring their sense of identity, a central element of which will be their
movement towards emotional self-expression. While this can be both con-
fusing and complex, practitioners can facilitate a client’s process by asking
carefully crafted questions that elicit opportunities for personal reflection.

Debbie (aged 14) has the physical maturity of a person some two years older and
I sense certain adults in her life think of her as someone who should behave like
a 16 year-old. They become frustrated when Debbie behaves as the 14 year-old

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Directive and Non-directive Therapy  109

that she is. Not only does she struggle with this situation, but it also seems to
create confusion and conflict with Debbie’s peers and adults alike. Figure 8.2
illustrates the complexities encountered by Debbie in moving from childhood
into adolescence.

Figure 8.2  The Emerging Young Woman – the gradual transition from
childhood to adulthood is a time of immense change and
confusion

Another instance concerns Gareth (aged 16), who four years earlier had to cope
with the divorce of his parents when he relied upon his girlfriend for emotional
support. His apparent dependence caused her to end the relationship, serving as
a poignant reminder of his parental relational breakdown. Both Debbie and
Gareth looked to me for answers. Believing they might use their inner resource-
fulness, I offered a range of possibilities and explored with them the potential
consequences of each perspective. Neither Debbie nor Gareth had previously felt
they owned the means to address their needs. However, when I offered perspec-
tives that might be appropriate to their individual circumstances, they indepen-
dently worked out what they needed for themselves and subsequently told me,
with satisfaction, what they had put in place.

It could be argued that both these illustrations veer away from the non-
directive purity generally associated with the person-centred approach.
Within the context of child-centred therapy, I believe direction can be appro-
priate if the following conditions are met:

•• The child-centred model described in Chapter 2 provides the foundation upon


which a therapeutic relationship is established. At all times the practitioner is

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110  Person-centred Therapy with Children and Young People

attentive to the client’s way of being and places the child or young person at the
heart of that relationship.
•• When a client seeks direction on a particular issue and the therapist feels it will
facilitate the client’s emotional process, alternative possibilities will be expressed by
the therapist with care and diligence. Direction will be offered with deep respect for
the client’s needs within the context of his/her life and present circumstances.
•• The practitioner does not advise on a specified course of action but rather
contributes suggestions and offers perspectives for the client’s consideration. These
perspectives may include the views or feelings of significant others associated with
the matter being explored.

I would like to offer an example to demonstrate what I mean about offering pos-
sible perspectives. Isobel (aged 15) came to see me and talked about her struggle
to maintain friendships. She spoke about a friend (Sophie), who had been close
for some while, and that they would confide in each other. Sophie had a spell of
absence from school following a build-up of emotional tensions and rejected
Isobel’s attempts to contact her at home. Not surprisingly, Isobel felt hurt and
wondered what she must have done wrong. Talking this through, Isobel also
spoke about her anger towards Sophie. Tentatively, I wondered how Sophie might
be feeling, but Isobel could not identify this. I asked her if she would like me to
describe how Sophie might be feeling and Isobel asked me to do so. With my
empathic sense I talked about how Sophie could be finding it hard to come to
terms with her condition, that Sophie was not necessarily rejecting of Isobel but
might be embarrassed and not know what to say. Also, it was possible that Sophie
might be concerned that talking about her ill-health might come between them
and change the nature of their relationship.
Having reflected upon these possibilities, Isobel came to the next session and
described feeling more at ease about Sophie. She had made a decision that when
Sophie returned to school in a couple of weeks, Isobel would renew contact on
Sophie’s terms and look beyond her own feelings of anger and rejection.

Exercise

When would you consider it appropriate to offer direction to a child or young


person? Illustrate your answer with worked examples.

Summary
This chapter explores the terms ‘directive’ and ‘non-directive’ in the context
of child-centred therapy and proposes that direction can be offered within
strictly founded principles and be true to the core considerations described
in Chapter 2. There are occasions when it may be appropriate to offer direc-
tion to a child or young person and its form is carefully explained. It should

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Directive and Non-directive Therapy  111

not be confused with a broader interpretation of directive therapy utilised in


other modalities.

Suggested further reading

Cain, D. J. (ed.) (2002). Classics in the Person-Centered Approach: The Best of the
Person-Centered Review. Ross-on-Wye: PCCS Books.
Mearns, D. (1990). Developing Person-Centred Counselling. London: Sage.
Mearns, D. and Thorne, B. (2000). Person-Centred Therapy Today: New Frontiers in
Theory and Practice. London: Sage.
Moon, K. (2002). Non-directive client-centered with children. In J. C. Watson, R. N. Goldman
and M. S. Warner (eds), Client-Centered and Experiential Psychotherapy in the 21st
Century: Advances in Theory, Research and Practice (pp. 485–92). Ross-on-Wye: PCCS
Books.

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9
Play, Materials and Dialogue in
Therapy

Covered in this chapter:

•• Introduction
•• Conversation in child-centred therapy
•• Expression through informal play
•• Symbolism
•• Playroom equipment and facilities
•• Practical play applications

Introduction
I use the term ‘child-centred therapy’ to describe a therapeutic approach to
working with children and young people under 18 years of age. We already
know that the preferred likely means of communication for young children
will be through the use of play and materials. It is also evident that people
in their mid to late teenage years will prefer speech as their means of com-
munication. Either end of this age/communications continuum is relatively
easy to define but a challenge for the child-centred therapist is to offer con-
ditions for the relationship that enable a child or young person to identify
his/her personal preferences. It must not be assumed that a 14 year-old boy,
for example, will prefer to engage in talking with the therapist rather than
self-explore through the use of activities. Equally, it is important not to take
for granted that any child under the age of, say, 12 years old will prefer to
use play and materials. It is human to make judgements on a daily basis.
Children and young people are no different but practitioners need to

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Play, Materials and Dialogue in Therapy  113

transcend those conditions to offer unconditionality that is both free of


judgement and assumption. Experience and openness to new forms of
expression enable practitioners to harmonise with individual client prefer-
ences. A 13 year old might assume that the therapist expects him/her to talk
as the basis for the relationship. In turn, an inexperienced child-centred
practitioner might be tempted to assume that this individual prefers spoken
communication. The experienced therapist takes nothing for granted on the
age/communications spectrum and makes play and other materials avail-
able so each individual can choose what will suit him/her.

Conversation in child-centred therapy


Verbal dialogue with children and young people is often challenging for new
practitioners and the following points may go some way towards explaining
why this may be the case:

1 Anticipating, planning, determining and directing communications with others from


within the reality of each individual’s experience is human. This gives rise to, for
instance, an adult judging or construing how a new young client will initially be.
Meeting somebody for the first time, we register the features individuals appear to
us to present – what might be termed ‘first impressions’.
2 Children and young people may present to the practitioner variables not encountered
with adult clients, reflecting their age, ability to comprehend, confidence in com-
municating with the adult practitioner, level of emotional development, intellectual
capacity and state of maturity.
3 Being present for the child, practitioners need to be open to their personal childhood
experience. Unless, in their training, therapists have been able to reflect in depth
upon their upbringing, something of their experience is likely to arise (perhaps at the
least opportune moment) when working with children and young people.
4 Successfully ‘pitching’ conversation with a young client needs the practitioner to be
mindful of the circumstances in point 2 above. Conversation has to be understand-
able to the client, avoiding inappropriately complex or simplistic explanations. To
be experienced as patronising, teaching or in other ways talking ‘down’ to a young
client is an unequal relationship.
5 Practitioners need to communicate effectively with young clients: while providing
an equal relationship, it is necessary to maintain the boundaries for effective thera-
peutic interaction and safety for both client and practitioner, including, for instance,
confidentiality.
6 Occasionally, clients may consider using play and materials to be ‘childish’, yet they
may also experience difficulty talking about their feelings.

In child-centred therapy, speech is used in a variety of ways. Therapy does


not simply translate into those who play and those who talk – that would be
too easy! Children who prefer mainly play in therapy will also talk to the
therapist and/or about the activity with which they are engaged. There are
variants and I illustrate this with some examples:

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114  Person-centred Therapy with Children and Young People

•• Starting a session by talking about the things that concern them, young children then
move – often quite abruptly – to an activity. It is as if they wish to complete the
‘business’ part of the session, to get that out of the way before playing.
•• Undertaking activities throughout the session and amalgamating it with talking about
what is on their mind, young clients focus on the task and at the same time talk. This
might occur when a client is uncertain about the possible response of the practitioner.
•• Sometimes children choose to exclude the practitioner from their activity by making
potent use of body language. Focusing on an activity can enable a young client to
avert his/her gaze from the therapist even though the therapist is at all times offering
eye contact and listening attentively.
•• Younger children particularly may communicate through play with minimal use of
direct speech. The practitioner needs to be alert to the silent messages being con-
veyed and will describe what the child is doing and in this way is able to reflect the
child’s actions. The therapist maintains communication within the context of what
is actually happening and does not openly interpret the client’s actions as having an
alternative meaning.

Exercise

What personal issues might you need to reflect upon in developing an effective
dialogue with children and young people?

Expression through informal play


Rogers (1939: 302) described expressive therapies that are ‘methods of treat-
ment which rely almost entirely upon the expression of feelings by the
child, with the therapist taking a minimum part in the process’. He also
referred to the ‘curative powers of expression’ and its usefulness ‘wherever
there is anxiety and perplexity growing out of past situations’ (Rogers 1939:
305). Rogers touched on the use of expression through play techniques as
seeming ‘to have constructive value’ and he referred to the work of Levy
(1936) as a leader in the experimentation with dolls as a means of therapy
with children. Levy’s work endeavoured to put his techniques on a more
controlled and scientific basis, and Rogers pointed out that when play mate-
rials are utilised in therapy ‘it is not done on such a formal or controlled
basis as that described by Dr Levy’. Rogers refers to the ‘informal use of
play techniques’ and says: ‘Free play … may be just as valuable in permit-
ting the child’s expression of emotion’ (Rogers, 1939: 310). In child-centred
therapy, I use Rogers’ description of informal play techniques simply for
consistency and to distinguish these from methods that are structured and
controlled – possibly categorised as formal play. Rogers said that with free
play ‘any strict comparison between cases is out of the question’ (Rogers
1939: 310). While concurring with this assessment to a certain extent, in my
experience, it is possible to track movements within and between sessions
of individual children.

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Play, Materials and Dialogue in Therapy  115

Froebel commented: ‘The purpose of playthings, and occupation material


in general, is to aid the child freely to express what lies within him – to bring
the phenomena of the outer world nearer to him, and thus to serve as a
mediator between the mind and the world.’ (1895: 169–70). Bühler (1933:
37–8) asked the question:

What consequence and effect does the activity with material really have on the
development of the child, and indeed on the development of mankind...? The
absence of practical activity, the lack of experience in all practical things of life
seems, therefore, one of the important factors in determining the whole level of
development of the child.

Froebel (1912: 50–1) also stated: ‘Play, then, is the highest expression of
human development in childhood, for it alone is the free expression of what
is in the child’s soul.’
Describing a range of materials that might feature in play, not all materials
will be utilised by every practitioner. A generalist play practitioner with a
gift for music may use some aspects of music in the activities and materials
available to young clients. In common with a number of play activities, some
practitioners will specialise in, for instance, music therapy, for which special-
ist training and professional associations exist.

Art
Art can offer independent indications about what is occurring for children
in their inner and outer worlds. Silverstone (1997: 2) describes her enthusi-
asm for the ‘harmonious marriage of the person-centred approach and art
therapy’. Seeing the benefits in her work as a school counsellor, Silverstone
started to ‘note the limitations of mere words … began to search for some
other mode of knowing’. She goes on, ‘I learned that images, like dreams, tap
into the world of spontaneous knowing, nothing to do with thoughts’ (Sil-
verstone, 1997: 1). Silverstone went on to train as an art therapist.
Painting and drawing gives credence to a child’s inner creative urges and
does not require spoken language. The therapist offers a child freedom to
express and accepts the results as valuable to the child. Artwork can offer
helpful insights in the context of what is already known about that child and
may be significant for what is missing, inferred as well as what is repre-
sented. Viewing a child’s chronological series of paintings or drawings on a
particular subject can be enlightening.

Charles, a boy of 9, had a rather dysfunctional upbringing. When I started work-


ing with him, Charles decided he wanted to paint. His first piece covered the
page with black paint and he went on like this for some sessions, gradually
diminishing the intensity of the black paint and adding in other colours. Over

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116  Person-centred Therapy with Children and Young People

(Continued)

time, Charles chose to paint seaside scenes using bright colours and then apply-
ing a black overlay, occasionally asking me to help paint over and conceal his
initial painting. Charles eventually painted colourful seaside scenes without
obscuring them. Despite feeling tempted, I did not interpret his artwork, but I felt
it provided a significant insight to his inner experiencing.

Seven-year-old Gemma struggled to cope with the divorce of her parents, who
jointly shared parental responsibility – each on a half-time basis. While undertak-
ing a variety of activities, her paintings followed a similar format, consisting of
roads and houses (Figure 9.1).

Figure 9.1  G
 emma’s Homes – a portrayal of her life between two homes
connected by roads

Gemma would identify the houses occupied by her mother and father: these were
invariably at the furthest point they could be from each other. Occasionally, the houses
were a little closer together (although never adjacent) and periodically Gemma might
paint the garage doors a similar colour. It was as if Gemma was relating to something
she could not influence – her parents. Each had one home but Gemma had two.

Evie (aged 6) drew a picture of her family (see Figure 9.2) about two years after her
father died in a fall. The drawing depicts the family home and shows the family unit
as three females and one male – a likely association with the immediate period fol-
lowing this tragic event. For three months following her father’s death, Evie’s maternal
grandmother lived with the family and has since been a regular presence in her life.

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Play, Materials and Dialogue in Therapy  117

Figure 9.2  E vie’s Family – a drawing of her family two years after her
father died in a fall

What I constantly find interesting is how children are able to express feelings
in their drawing with such simplicity and also directness. Figure 9.3 shows
how a minimalist drawing of two ‘stick’ people can so readily convey the
intended feelings.
Conversely, Figure 9.4 portrays quite complex feelings that describe the
end of a marriage.
The primary figures (parents), both demonstrably unhappy, are looking
away from each other. The figure in the middle is thought to be the child,
who appears to be angry with the mother. The child is elevated, which sug-
gests that, in the moment, she is looking down on her mother. Interestingly,
the key shown below the man is thought to denote the fact that the child’s
mother left the family home leaving the father and child.

Clay
Clay is a modelling material that comes in a number of forms. My preference
is for nylon-reinforced clay – it is not too messy and can be used over and
over again. Children can experiment with the material and there are no
restrictions as to its use. They may create scenes, such as a living room, that
can be intricate, laying the table and serving food, characters in a wrestling
ring, a tropical jungle with wild animals. Possibilities allow children to

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118  Person-centred Therapy with Children and Young People

Figure 9.3  S tick People – a powerful expression stated succinctly and


directly

Figure 9.4  B
 roken Marriage – a drawing that conveys complex feelings with
clarity

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Play, Materials and Dialogue in Therapy  119

explore with imagination and freedom – an activity they can do on their own
or with the therapist, but it is important the child is in control. Asking the
therapist to make a particular object and directing its shape, form and posi-
tioning, the therapist participates with the client’s consent, is observant of all
stipulated requirements and carefully clarifies any ambiguity to ensure com-
pliance with the child’s directions.
When children choose to work with clay, they tend not to have a particular
theme in mind at the outset and what emerges often does so through an
inner unplanned expression via their hands. Clay is not only used for imag-
inary expression but it can also provide a safe medium for exploring feelings
and situations knowing that, when the session is over, the product will
revert to a shapeless lump of clay.
If a client decides to play with clay, then the child selects that material for
a purpose that may not be immediately apparent either to the child or prac-
titioner. If the child is able to use his/her fingers to manipulate the clay and
the practitioner says something like, ‘Your hands are working out what to
make’, this is a direct acknowledgement of where the child is at that moment.
This validation demonstrates the practitioner’s attentiveness to what the
child may be working towards.

Emily (aged 8) decided to create a changing room adjacent to a swimming pool.


She involved me in making this scene and told me about a young boy who one day
sneaked a look at the girls changing. We talked about this for a few moments while
Emily carried on her work and I validated her feeling that this was not a nice thing
for the boy to do. I asked Emily if she would like me to mention this to her mother
at the end of the session and she decided that with me present, she would describe
the scene I had helped create. This enabled Emily, with confidence, to describe her
experience and her mother was able to locate the event and further reassure Emily.

I ask my client for permission to take a photograph after leaving at the end
of the session and then clear away the work. While children do not always
ask at a subsequent session to see the photographs, I will have them nearby.
Occasionally – albeit very rarely – a child might say that he or she does not
want a photograph taken and, of course, I will respect that request.

Puppets
Puppets have a variety of uses in symbolic play and as a therapeutic aid
(Irwin, 1983). When I meet a young child for the first time I may welcome that
child with a puppet from my collection. It is an effective ‘icebreaker’ and
rarely fails. My puppets are in essence a ‘family’ of different animals that
have their own names and characteristics. Collections can comprise human
figures, mythical figures, animals, etc. depending upon each therapist’s pref-
erences. A shy child may use a puppet to communicate with the therapist and

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120  Person-centred Therapy with Children and Young People

a puppet can be effective as a ‘go-between’. In this way, a child may cause the
puppet to communicate with the practitioner using actions that reflect a wide
range of feelings and by speaking in the manner of a ventriloquist. The con-
versation takes place between the therapist and the puppet. Children also use
puppets for play that may seem quite rough and it is therefore important to
choose puppets that are tolerant to rough handling.

I am reminded of Alice (aged 4), whose father died suddenly. Peter (one of my
animal puppets) was a favourite of hers and she would give Peter a really hard
time, being angry at not doing what he was told. My empathic connection with
Alice was such that it seemed that Peter needed to be disobedient and inattentive
in her presence. I sensed her grief for her father was communicated through the
strength of her feelings towards Peter but at no time did Alice speak of her father.

Stories
Stories feature in my activities since telling stories and writing will be familiar
to most children. Crompton (1980: 116) says: ‘For children under some kind of
stress, written communication may be of considerable significance.’ Lacher et
al. (2005: 49) comment: ‘Words have the ability to shape our thoughts, feelings,
beliefs, actions, and relationships.’ Siegel and Hartzell (2003) describe stories
allowing readers to see them as connected to the past, present and future:
readers may take on the perspective of the hero or main character.
Occasionally I decide to write a story for an individual child intuitively
reflecting the child’s circumstances, needs and emotions. The completed story
will be given to the child with the suggestion that the story is read to him/her
by a parent at a quiet time – perhaps at bedtime. The story is able to offer a
means for interaction between parent and child. Here is a story – Sparky the
Perspicacious Mouse – I wrote for 10 year-old Emma (Figures 9.5 and 9.6). She
wanted a story to include her two friends and their horses and also decided
the pseudonyms I was to use. See if you can get a feel for Emma’s character.

There lived in a small village in the north of England, three girls who were good
friends and had been since they started school five years earlier. They each had a
horse, belonged to the same pony club and shared the same riding instructor.
The horses, Venetia, Kiwi and Monty, spent much of their day during school
time in a field on the edge of the village. Venetia had recently moved to this field
from another stable about ten miles away and seemed to be quite settled in her
new surroundings.
The girls would let the horses out of their stables before going to school
and when school ended for the day, they would go to the stables, change into
their riding clothes, clean out the stables and groom the horses. At weekends
they would sometimes ride out together but this depended on what else their

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Play, Materials and Dialogue in Therapy  121

families were doing. There were times when one of the girls might be on her
own while her friends were committed to family activities. Most weekends,
however, the girls would try and spend some time together riding and
grooming their horses.
Since the girls had known each other for such a long time, they seemed to
enjoy the same things: their horses of course, but also their interest in reading,
popular music and even a liking for the same kind of food. They were happy to
be in each other’s company and when one of them was sad or unwell, the others
would do a bit extra to make sure the horses were content. They were such a
support to one another that often they could work out something wasn’t right
without having to say anything. Their closeness had been really special but over
the last few months it began to seem to Emma that their relationship was
changing. Emma, by the way, was Venetia’s owner and before I forget to say, Kiwi
belonged to Izzy and Monty was Rebecca’s horse.
Emma could not work out why things were different: she just knew that they
were and it troubled her. Sometimes she found it hard to sleep at night wondering
what might be going on. Emma chose not to talk to her friends about this: she
didn’t know what to say and thought Izzy and Rebecca might think she was being
silly. What Emma didn’t realise was that as they were growing, each girl –
including Emma – was beginning to make small changes in the way they felt
about things. They had been so used to thinking the same thoughts and speaking
the same words, Emma felt as if the past was disappearing. What she didn’t
realise was that her two friends also felt this way.
Emma was on her own at the stables one Saturday when Izzy and Rebecca
were away for the day with family activities. She let the horses out into the field
and got on with mucking out the stables. Tired and just a bit exhausted, Emma
sat on a hay bale watching Venetia, Kiwi and Monty racing around the field.
While she drank water from her bottle, Emma’s thoughts wandered once again
to her best friends: what they might be doing right now and what had changed
between them.

Figure 9.5  Sparky

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122  Person-centred Therapy with Children and Young People

(Continued)

As she sat there in a bit of a dream, she heard in the distance a small voice say
“Hi!” Then came that voice again “Hello, anybody in?” Emma’s thoughts slowly
came back to the moment and she looked down to her left. “Oh, there is
someone at home”, said the voice. Convinced that she was dreaming, Emma
rubbed her eyes and looked down again.
“I’m down here” the voice remarked and to her astonishment there,
leaning against the hay bale preening his whiskers, was a mouse. Emma
thought to herself, “This is ridiculous. I can hear a voice but I am seeing a
black mouse with a lovely shiny coat. This doesn’t make any sense.” Just then
Sparky – for that was his name – piped up and said, “I’m Sparky and I am a
mouse. This is me talking.” Emma could not believe what she was hearing and
seeing. Sparky said, “Cat got your tongue?” Looking around to see if there was
anyone else nearby, Emma decided to say something to the mouse. While she
felt a little foolish, she summoned up the courage to say something. “D-d-d-
did you say your name was Sparky?” Without hesitation came the response,
“Yes and do you have a name?” She said “I think I’m Emma.” Quick as a flash
Sparky replied, “Aren’t you sure?” Emma said, “I-I-I-I am but why am I talking
to you?”
Leaning on his tail against the hay bale, Sparky folded his front legs – a bit like
arms – and with some irritation said, “It’s the same with all you humans. You think
you’re the only ones that can talk, but that’s where you’re wrong. I bet I know
more words than you. Do you know perspicacious?” Emma had to admit that she
didn’t and quite softly asked, “What does that word mean then?”
“You really don’t know?” Emma shook her head a little sheepishly, hardly
daring to move. “Well” said Sparky, “It means perceptive and shrewd.” A little
more confidently now, Emma responded, “I’m afraid I am not really sure about

Figure 9.6  Sparky – Emma was in a dream wondering about her friends
when she heard a small voice say “Hi!”

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Play, Materials and Dialogue in Therapy  123

those words either.” Rather more gently now, Sparky said, “It doesn’t matter what
these words mean and I’m sorry for showing you up.”
By now, Emma was feeling a little more confident talking to Sparky, “That’s
all right” she said, “You do seem quite clever.” “No, not really, it’s just that I’ve
been around a long time and picked up words and things.” He went on, “You
know, Emma, as you get older you get to know more about what goes on inside
you. The other thing is that if you listen to your feelings, you will be able to trust
them. It’s not that you have to ‘learn’ feelings like you learn lessons at school.
Your feelings have always been inside you but maybe you don’t know how to
listen to them.”
“That’s silly” replied Emma, “Of course I know how to listen: I do it all the
time.” Sparky rubbed his chin with one paw, “It seems to me that you are very
good at listening to other people but are you any good at listening to yourself?”
Emma said, “I don’t know what you mean, but I often talk to myself and that’s
why it can be hard to sleep sometimes.”
Sparky pondered for a moment then said, “I think that what other people say
and expect is more important. So, when a problem occurs, you react to what
other people might think instead of how you feel.” At this point, Venetia ambled
over to the fence rail near to Emma and Sparky. “Hi, Sparky” said Venetia.
“Hey, wait a minute. Do you two know each other?” exclaimed Emma. “Of
course”, replied Sparky, “We go back a long way together”. “But you can’t”
Emma said, “Venetia has only been in this field for two months.” Venetia let out
a gentle snort, “When you brought me in the trailer to this field, Sparky came
too.” Now it was Emma’s turn to be thoughtful, “Oh, I didn’t realise. Come to
think of it, Venetia, I didn’t know you could talk too.”
Venetia responded, “That’s because when you talk to me I just listen. Did you
know that you speak to me about how you feel not just what others think?” Emma
shook her head and said, “No, I didn’t. Are you telling me that all this time I have
known you, you have understood what I have been talking about?” Venetia said,
“Pretty well, yes”.
At that moment Emma looked down to find that Sparky had disappeared. This
bothered her but Venetia rubbed her nose against Emma’s hand and said, “Don’t
worry, Sparky isn’t far away.”
“The thing is” said Emma, “Why is it that when I have told you things before
you haven’t told me what you think?” “That” said Venetia, “is because your
feelings are more important to you than what I think, just as my feelings are
important to me.”
“You mean to say that when I talk to you and you listen to me, you are letting
me say my feelings? I never knew that before,” said Emma. With that Venetia
nodded her head and without another word, trotted off to her friends on the other
side of the field.
Emma was speechless and her mouth was open in disbelief at what had taken
place over the last few minutes. No one would ever believe that Venetia and
Sparky had talked to her, let alone that she’d had a conversation with them. Well,
her friends might believe the last bit.
That night, Emma slept soundly for the first time in a few weeks and the next
morning, before it was light, she got up early and ran to see Venetia in her stable.

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124  Person-centred Therapy with Children and Young People

(Continued)

When she got there, Emma expected Venetia to speak to her. Instead she greeted
Emma with a soft neigh and simply listened to her talk about how she had a really
good sleep and would be back in a little while after Sunday breakfast to let her
into the field.
When Emma left, Sparky nudged Venetia’s ear – for he had been hiding in her
black mane almost like camouflage, “I wonder if we have helped her”. Venetia
thought for a moment, “I think we have, but now she knows she has us to talk to,
Emma will start to trust her feelings. What she didn’t understand was that she was
listening to them all along and would ignore her feelings if someone else said
something different.”
“For a horse” said Sparky, “you are quite wise yourself”. Venetia whinnied and
shook her head. With a gentle thud Sparky fell to the straw.

Dramatic play
Many children spontaneously enter into dramatic play when they assign
roles to themselves and the therapist. Chapter 1 described the 8 year old
child who initiated a role-play activity in which she was the teacher and I
was the pupil. She was able to explore feelings around being in charge and
what it felt like to issue instructions. Dramatic play includes all variations,
from mime to improvised acting, role-play, or a set play. Some children ‘act
out’ when they let dolls or other characters take roles representing them-
selves and others close to them.
Jennings (1999: 119) says: ‘Dramatic play can be said to be at its most ful-
some and effective when the therapist and child are both engaged in imagi-
nary characters.’ She also describes how ‘Our roles expand as we relate to
the wider world and we experience both the chance to play roles and the
chance to witness them being played by other people’ (p. 120).
Dramatic play can be used effectively with people of all ages. Drama is a
form of specialist psychological therapy in which clients (as described by
the British Association of Dramatherapists) engage in bringing about psy-
chological, emotional and social change. Through an indirect approach,
clients are able to explore difficult and painful life experiences. For instance,
drama therapists work with children and young people who have specific
needs, such as those, for example, on the autistic spectrum and those who
self-harm.

I recall working with Mark (aged 17), who found it hard to communicate both
with peers and others but who wanted to do some further training. With parental
encouragement, Mark met with me regularly. While he found it hard to engage
in conversation, he was always willing to try anything I might suggest. After a
while I introduced Mark to role-play and he took to it enthusiastically. I would

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Play, Materials and Dialogue in Therapy  125

describe a scene in which we both played a role. We might act the scene from
different angles: for instance, he might be pushy or uncertain and I could be shy
or dismissive. We also used role-play to help develop Mark’s confidence to attend
interviews and engage in social activities. In time, Mark was able to secure work
experience and attended a residential college course. This is an example of
drama used in therapy (not drama therapy per se).

In a limited way – safely within the scope and confidence of the generic
practitioner – drama has a legitimate place. Practitioners who find they have
an interest in drama or any of the other therapies described in this chapter
can seek specialist training.

Toys and materials


These need to be carefully selected since their choice is essential in providing
children with opportunities for self-expression through their play. As Lan-
dreth (2001: 13) says: ‘The type of toy a child uses can determine the type and
extent of play exhibited, and thus the degree of self-expression. Unstructured
toys can be used by children in many ways to express themselves.’ Rubin and
Howe (1985), in their review of literature on children’s toys and the types of
play associated with them, noted that for younger children, realistic toys tend
to be more conducive to facilitating pretend play than are abstract toys. The
opposite reaction was noted with older children. Neumann (1971) stated that
ambiguity and diversity of materials tends to foster creative play in which the
child can ascribe an identity and function to the object. He said ambiguous
materials tend to facilitate reflective, transforming responses, whereas realis-
tic and elaborate materials facilitate stereotyped exploration.
Landreth (2001) describes three broad categories of toys and materials
facilitating self-expression by children: (a) real-life toys, such as figures, ani-
mals, cars and tea sets; (b) acting-out and aggressive-release toys, which might
include warriors, pretend guns and lightsabers; and (c) toys for creative expres-
sion and emotional release, including sand and water, which Landreth describes
as unstructured play media that are ‘excellent for expressing feelings’.
On the subject of weaponry, practitioners may be tempted, as was I ini-
tially, not to provide these play toys. I felt that I could in some way be con-
sidered as contributing to or condoning aggressive behaviour that I did not
believe had a place in my room. During this period I became aware that
children were inventing their own ‘weapons’ and I gradually acknowledged
that I was reflecting my need to impose this restriction. Having addressed
this issue, I added some suitable toys to my collection and these came to be
regularly used by boys especially. Sometimes clients created play fights in
which carefully selected characters would take sides, the object being to
overwhelm the enemy. At other times, I might represent the enemy to be
‘attacked’ and defeated, either being killed off or overwhelmed.

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126  Person-centred Therapy with Children and Young People

Construction toys
Construction toys can include such items as Lego, Meccano and jigsaws, to
name but a few. While Lego and jigsaws tend to be age-appropriate, Meccano
is likely to be used only by older children since it involves intricate manual
dexterity. Using construction toys, children may express how they have felt
when a part of their life may have broken down or when it has been rebuilt.
Lowenfeld (1969: 51) says of destruction, ‘the desire to destroy, since it is so
rigorously suppressed by adult society, must be given special opportunities
for satisfaction’ in child-centred play. Chapter 5 offers an example of a young
client’s use of a construction toy in therapy.

Board games
Board games are not always approved of by therapists, perhaps because
these games normally follow a set of rules and some might describe this as
being inconsistent with the child-centred approach. I choose to use board
games, including chess and draughts, in which my client determines the
rules. I do as my client instructs with the consequence that I nearly always
lose! When I play chess with a young client, for instance, I do not set out to
try to lose and I am not sufficiently proficient to aim to win. That my client
and I are in a relationship is most important and if he/she makes an undesir-
able move I might simply say, ‘You may not want to do that’. They will then
rethink that move and usually change their mind. Naturally, I am not per-
mitted to change my mind!
I take it as an encouraging sign when a child who, early in the relation-
ship, insists on adhering to the formal rules, then slowly finds the means to
develop their own rules. Knowing the background of the client, this shift can
symbolise aspects of his/her ability to take control in circumstances in their
lives where they have come to feel powerless.

Sand and water


Sand and water have been described by Jennings (1999) as media that enable
a child to play projectively – where play ‘can be exploratory, sensory and
manipulative’. Sand and water are excellent for expressing feelings: as Lan-
dreth (2001) says, children can use sand to express their aggression by
manipulating the sand and burying items in it while water allows children
to act out those times when they need to regress to a previous stage in their
life experience. Sand and water are ‘reversible play materials that allow chil-
dren to change the identity of the object. When the scene being played out
becomes too frightening or intense, the child can make the play material turn
into something else’ (Landreth, 2001: 15). Lowenfeld (1969) pioneered sand
play and therapy in what she termed the ‘World Technique’, enabling chil-
dren to express their inner world through toys in a sand tray. She used a

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Play, Materials and Dialogue in Therapy  127

wide range of objects: natural materials, figures, animals and other real-life
toys. Lowenfeld also emphasised the importance of sand, as well as sand
and water, in simulating a variety of landscapes and seascapes. Sand play
can be used as a ‘stand-alone’ therapy and also alongside other play therapy
approaches. Specialist sand tray therapists may use sand play not as a ‘one-
off’ but as a series of photographed sand trays made over many weeks that,
when concluded, offer an insight into the client’s process.
The tray represents a safe and contained environment within which a
client can create stories, scenes, abstract patterns, and so on. Using a rec-
tangular sand tray with the bottom and sides painted blue to represent
water and sky, the tray (52cm × 72cm × 7cm) encompasses a client’s normal
visual field. Dora Kalff, a Jungian therapist from Zurich, studied with
Lowenfeld, and she determined these dimensions. Optimally, two sand
trays might be available of which one will be used for slightly damp clay,
the other remaining dry.
Objects will be carefully laid out for a child or young person to select from
and selection seems to work particularly well if clients let the objects ‘choose’
themselves. The process is spontaneous and without a preconceived plan, in
which symbolism is frequently a key component.
The therapist is silent in the process of ‘making’ the tray, recording the
objects used, the order in which they are placed in the tray and their relative
position. Once the client is content with their tray, the therapist then invites
him/her to tell the ‘story’ of that tray. A young child may offer a factual
statement of what has been used or may offer no description. Older children
may tell their story and describe what it means to them. This can be recorded
by the therapist and, when completed, read to the client. The therapist seeks
the client’s consent to photograph the completed sand tray, normally leaving
the tray untouched until the client has left.

Music
Music is a therapy for which specialist training is available. Nevertheless,
this is something a generic, child-centred, musically talented therapist may
also choose. Instruments may form part of the therapist’s collection but care-
ful selection will seek to ‘manage’ the decibel levels of each instrument
within the surrounding environment. Where conditions are constrained, a
collection of ethnic hand percussion instruments might, for instance, include
items such as a karimba, agogo, chimes, monkey drum, bodhran drum,
castanet rattle, kelele shaker, tambourine and rain shaker. As mentioned in
Chapter 3, rhythm is a major feature of the human condition: Levitin (2006:
223) says, ‘inside the womb, surrounded by amniotic fluid, the fetus hears
sounds. It hears the heartbeat of its mother, at times speeding up, at other
times slowing down’ and Levitin describes research by Lamont (2001) in
Levitin (2006: 223) who found that, ‘a year after they are born, children rec-
ognise and prefer music they were exposed to in the womb’.

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128  Person-centred Therapy with Children and Young People

Moreno says the purpose of music play therapy combines the benefits
of the non-directive play therapy setting to integrate greater structure
(the music play materials) into the process. ‘Non-directive music play
therapy takes place in a playroom supplied with musical instruments
instead of toys’. Children are free to explore their feelings through music
(1985: 17).
Kruger (2001) stated that music could be used in all facets of a child’s life,
namely physical, emotional, spiritual and social. Oaklander (1988: 115)
wrote: ‘Music and rhythmic beats are ancient forms of communication and
expression.’ In Oaklander (1988: 115), Dreikurs (1965: 201–2) said:

This work (music therapy) brought results in cases where other approaches had
failed. It seems that the pleasant experience with music, often merely in the back-
ground, stimulates participation, permits an increase in the child’s attention span,
and raises his frustration tolerance. External and internal tensions disappear, as
reality becomes more pleasant and less threatening. The demands for participa-
tion are so subtle that they are not resented or defied.

Writing music and lyrics is a way that some young people find helpful as a
method of expressing feelings that are important to them. These lyrics, written by
Jonathan when he was aged 15, describe his feelings around the time of his
mother’s death. She died from cancer when Jonathan was 9 and people told him
that she would be looking over him even though his family was not religious. The
lyrics also contain a reference to how little he remembers of what she taught him.

When you walked down, that open road,


Light fading slowly and all that I know,
You taught me that, no matter where,
You’d watch over me, and always care.

But when you left, that cold April day,


I lost my fucking will, and I lost my faith,
That you had once taught to me,
You left me broken, now I can’t see.

How I’m supposed to stay,


With my faith intact and my trust in man,
Un-severed, un-scathed with no dismay,
So tell me fucking how!

Am I meant to believe,
That you’re watching over me?
A vacant space is all I see,
Your dying eyes, the long good bye,
It’s what makes me bleed, inside.

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Play, Materials and Dialogue in Therapy  129

Five years down, the long dusty road,


The promises that you gave, engraved in your bones,
It’s harder to believe now, than when you said,
That you’d be watching over me, even when you left.

But it’s now that, I need to believe,


All that you told me, it seems like a dream,
From a different lifetime, in years gone by,
If I could find my wings, teach me how to fly.

Up in the sky’s, where I know you rest,


Waiting up there, your heart beating in your chest.

Am I meant to believe,
That you’re watching over me?
A vacant space is all I see,
Your dying eyes, the long good bye,
It’s what makes me bleed, inside.

Baking
Baking is not something I have come across in therapy literature largely – I
suspect this is because of safety fears – so the inclusion of this section might
be contentious for some. Children experience satisfaction from cooking with
a family member: it is an activity from which they can gain enjoyment as
well as having the undivided attention of adult company and working
together. It is a feature of my work with which both boys and girls choose to
engage. What lies behind this choice will be personal to the individual but I
tentatively offer some explanations:

1 Baking is an activity in which both practitioner and child actively engage in the
creation of something positive.
2 Children may feel they would like to bake as an offering to their family and consider
this to be a gift of a feeling, such as love or regret, that they may otherwise find hard
to express.
3 It can provide the means to maintaining a bond with parents and grandparents that
children choose to replicate in therapy: equally, it is a way of expressing a desire for
perhaps a parent to provide such opportunities themselves.
4 A child and therapist can use the ‘vehicle’ of baking to talk about matters the client
wishes to communicate while focusing on the task.

Being out of my depth in the kitchen, I did not initially contemplate baking
being used in therapy. Nevertheless, through trial and error away from cli-
ents, I became confident and added this to my repertoire. Key points to bear
in mind are, first, the proposed task needs be contained within the session

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130  Person-centred Therapy with Children and Young People

time. This is particularly important when time may be needed for baking to
cool down prior to icing, for example. I soon discovered trying to ice hot
sponge does not work! Secondly, baking needs some planning ahead of the
session to ensure the ingredients are available. If there is something particu-
lar a child wishes to bake, knowing in advance enables me to purchase
whatever is needed. Thirdly, the need to maintain safe conditions for chil-
dren while the baking takes place requires the therapist to be vigilant. Of
particular importance will be the hot oven, the sharp knife or scissors, hot
water and the electric whisk. Some children may be cautious around such
hazards, while others may be over-confident, so the practitioner needs to
remain alert, remembering that the primary focus is the therapy.

Exercise

Consider what forms of play you might offer, perhaps with reference to your
childhood interests and experiences. Are there any areas you might decide to
avoid or defer until you have gained further training and experience?

Symbolism
Symbolism is an elemental component in work with children and young
people. Kalff (1980) talks about stabilisation of the unconscious expressed
through play, drawing and painting as well the ancient language of symbols,
such as circles, rectangles and squares, which may indicate completion and
wholeness. She writes: ‘We accept the validity of these symbols of the whole-
ness of the human psyche because they have occurred everywhere without
exception from the earliest times of man’ (Kalff, 1980: 24).
As Jennings (1999: 52) says:

Children explore their own relationship to other objects as well as garnering


them together in different types of relationships; things form patterns and shapes
and represent things for the child and we see ever increasing use of symbols.
Events and stories are dramatized through toys rather than the child taking on
the roles themselves.

Colours are themselves important and can have a symbolic language of their
own.
Axline (1947: 98) also spoke about the recognition of feeling and interpre-
tation, and said: ‘The child’s play is symbolic of his feelings, and whenever
the therapist attempts to translate symbolic behaviour into words, she is
interpreting because she is saying what she thinks the child has expressed in
his actions.’ She goes on: ‘A cautious use of interpretation, however, would

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Play, Materials and Dialogue in Therapy  131

seem the best policy with the therapist keeping the interpretation down to a
minimum and when using it, basing it upon the obvious play activity of the
child. Even then, the therapist’s response should include the symbol the child
has used’ (p. 98). Vinturella and James (1987) encourage the therapist to
avoid interpreting symbolic play. Its subjective meaning for the child must
be respected.
Goetze (2002) speaks of play presenting an opportunity for a child
symbolically to play out his/her experiences: ‘in therapy, the play offers
the possibility for the child to give a new order to its experiences, to
organise them and thereby bring them to consciousness’ (Behr and Cor-
nelius-White, 2008: 46).
Symbolism features prominently in child-centred therapy and I have
already offered several examples in this chapter using a range of materials,
including art, clay, puppets, toys and board games. I find that young chil-
dren intuitively utilise symbols as a means of expression, perhaps because
they are more confident in communicating by this means rather than the
spoken word. Possibly, it provides them with the means to convey their
feelings indirectly to the therapist in the hope or expectation that the atten-
tive practitioner will understand what is being communicated. Sometimes
I have found that a child’s words, combined with the activity they are
undertaking, together represent a communication that each element on its
own may inadequately convey. It is essential for the child-centred therapist
not to search for or to infer meaning. Anna Freud (1927/1928) cautioned
that the therapist has no right to impute symbolic meaning to a child’s
every action.
It is also not unusual for young people to talk, for instance, about a prob-
lem a friend is experiencing and wondering what the client might be able to
do to support that friend. The practitioner stays with the parameters of com-
munication expressed by the client and remains present in that abstract
context. Sometimes I may experience confusion but will remain acceptant of
my feelings, working ever harder to understand what my client is commu-
nicating. I can be true to my client’s expression without attempting to ‘con-
vert’ his/her use of language into something that conforms to my personal
framework of understanding. In this way, the young client who describes
the problem a friend is experiencing will not be asked by the practitioner if
the ‘friend’ is in fact himself/herself but will remain true to the reality pre-
sented by the client.

Exercise

In Tibetan Buddhism the mandala (a Sanskrit word meaning ‘circle’) is a symbolic


picture of the universe that helps to enlighten and assist with healing. Draw a
mandala to outwardly, symbolically visualise your world.

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132  Person-centred Therapy with Children and Young People

Playroom equipment and facilities


Facing the new child-centred therapist will be the environment in which
therapy is to take place and the materials to be provided. There is an array
of information describing optimum conditions and available materials. Ini-
tially, I found that not only did these bewildering expectations diminish my
confidence, it was also true that I could not hope to meet the space demands
that others deemed to be good practice. I felt that should I do anything less
than achieve the ideal, I would be unable to practise effectively.
The description I wish to offer is for the general child-centred therapist
and professionals in other fields, such as health and education, who want to
provide play facilities adapted to the role and context in which they are
employed. Provisions for specialised child-centred therapies, such as music,
sand tray, art and drama, are intended for therapists practising entirely or
principally within their specialised field. The relevant professional organisa-
tions have information on starting up and this is likely to feature in profes-
sional training.
Initial consideration should address available space and its location,
whether it is in a public or domestic setting. Practitioners need to work
with what is possible and conditions may not be ideal. It is incumbent
upon the professional to be realistic and practical. If it can be achieved, the
therapist’s room will be on a ground floor adjacent to toilet facilities and
perhaps a waiting area near to the main entrance. Safe and accessible pro-
vision should maximise privacy and client confidentiality. In my private
practice, I do not have waiting room facilities and I therefore have a
30-minute gap between the completion of one appointment and the start of
another. Aside from using the time to make notes, I also need to tidy up
ready for the next client: the space also minimises the possibility of clients
coming into contact with each other. My counselling room is used by chil-
dren as well as adults and, accordingly, wet activities involving extensive
clearing normally take place in an alternative space. When considering
what to provide in the counselling room, it is important for the practitioner
to have regard to the following:

1 Available space and how best use can be achieved. Assess constraints in terms of
floor area, noise transmission, surface finishes, accessibility and storage.
2 Room contents needs consideration, ensuring that items of value are removed so that
what remains can be subjected to minor damage without worrying the practitioner.
3 Ensuring the physical safety of the child in relation to typical hazards that might be
encountered in office or domestic environments, including furniture and play mate-
rials in the room. Hazards should be eliminated or effectively managed.
4 Provision of safe storage for a client’s work in progress until the next session, per-
haps in the room or taken elsewhere if appropriate.
5 It is difficult to conceive of every eventuality, and practitioners may find it helpful to
compile a plan that takes account of possible problems and how these will be man-
aged, recognising that it can evolve with experience. For example, what does the

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Play, Materials and Dialogue in Therapy  133

practitioner do (apart from panic!) if a client arrives for an appointment before the
previous client has left? If a waiting area is not available for parents while their child
is in session, what will be the arrangements for collecting offspring at the end of the
appointment?

I feel it is better to start with a small range of equipment and materials and
allow it slowly to grow. I have resisted assembling a ‘shopping list’, prefer-
ring readers to their build their own collection – what they feel comfortable
with. Do not feel that the most expensive items should be purchased, but
reasonable quality and durability is advisable. Periodically, the collection
can expand as needs and finances permit. Occasionally, young clients may
want to have the use of something not immediately available and I will, if
appropriate, do my best to get it. Computer games are excluded since I feel
they are not conducive to a meaningful therapeutic relationship.
Practitioners need to feel at ease with the equipment and materials they
make available to clients. For example, when children are painting at home,
they may be used to having only a small amount of paint at a time and par-
ents might not welcome the mixing of paints. In the session a child might
choose to decant more paint than is needed and make a mess with mixing so
that waste is incurred. The practitioner needs to be at ease in such a situation.
I always think it is a good idea for new items to be tried out with perhaps a
family member to establish what problems might arise in a therapeutic ses-
sion and thereby work out how those might be overcome. Some craft kits, for
instance, give the appearance of being straightforward but in fact therein can
lie unexpected difficulties, as I know only too well!

Exercise

You are a child aged 5. What would you like to see in your play space? Prepare
a starter list of equipment and materials you would provide in your play facility
and, in relation to the play space that might be available to you, what are the
benefits and drawbacks of the space. How might you be able to overcome the
limitations imposed by that space?

Practical play applications


The child-centred therapist seeks to be alongside the client during the session
and does not direct the client’s process. As described in Chapter 8, there can
be occasions when it is acceptable for the practitioner to offer suggestions
from which the client can choose what he/she feels is appropriate. In the early
stages of offering therapy, the practitioner may feel pressured to take the
lead – as if it is necessary for the adult to be ‘doing’ something to enable the ses-
sion to ‘flow’. In such circumstances the practitioner is demonstrably leading

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134  Person-centred Therapy with Children and Young People

the session. Practitioners will experience pressure but this needs to remain
outside the therapeutic relationship. Referrers may be looking for results and
attempt to ‘make’ the process produce a quantifiable and measurable out-
come. It is only with experience and confidence that practitioners can expect
to manage these pressures.
I have described activities and materials in therapy and I would now like
to offer some vignettes demonstrating my work with children and its rela-
tionship to the six conditions model developed by Rogers (see Chapter 2).
More significant than the choice of activities and materials, is the nature and
quality of the therapeutic relationship developed between two people. My
selection also reflects the potential for using activities and materials across
the age range of child-centred therapy.

Sand play – Katie, aged 15, decided that she would like to do a sand tray. When
faced with the sand tray, Katie’s approach to the tray seemed tentative and almost
child-like. I explained the concept and that she could choose how to ‘make’ her
tray. I said I would be quiet while she did her tray and record the items and their
positioning in her tray. If she wanted to tell me her story about the tray then she
could do so.
Katie selected the items for her tray, doing so carefully and thoughtfully.
Having placed these items, I invited her to tell me her story. She felt this would
be difficult and asked if it would be all right to describe her tray. I explained this
would be fine and she talked me through her work.
She then spoke about her inability to state her own needs and that she
continued to look for parental approval even though this was rarely
forthcoming. Katie’s words resonated with my feelings in relation to her
completed sand tray.
I asked if I could photograph her completed tray and she agreed to this.
In my notes I wrote: ‘Katie was unsure about the sand tray and how this
would work. I explained this and during the process of gathering items for the
tray she asked a number of questions, such as ‘How many items am I meant
to choose?’ I told her she had no rules to follow. When it came to telling her
story, I was aware of her caution and reassured her it would be fine to
describe her tray and that I would make notes. She then described her tray in
some detail.’

Baking – At the conclusion of his fourteenth session, Chris (aged 8) said he would
like to do some baking next time and between sessions I obtained the supplies.
At the start of the next session I asked Chris what he would like to do.
He first of all said he did not know and then said in a loud voice, ‘Baking!’
Chris was enthusiastic and wandered off to the kitchen with me following. This is
the first time I have done baking with a client and I was a little unsure how this
would work – or not. The day before I had bought a cake mix with cartoon
characters (I knew his mother loved a particular character) and carefully read the

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Play, Materials and Dialogue in Therapy  135

instructions. I assembled the ingredients and cooking implements with Chris,


who was eager to do everything at once.
When we finished the buns, he worked out how many each person in the
family would have. He wanted to make sure his younger sisters also had a share.
I found paper plates and cling film and then he asked for two bags to put them
in. I found two carriers: he put one plate in one bag and I put the other in another
bag for him. Chris then asked for a pair of scissors and cut one handle off each
bag, which resulted in the plates being on end rather than flat at the bottom of
the bag. I was a little puzzled but said nothing. Chris thanked me for letting him
do the buns. This is something that he would not have said a few months ago and
I felt touched by his remark.
We cleared up – something else Chris likes to do – and then went back to my
counselling room, knowing his mother would arrive soon. When she came in,
Chris showed her what he had been baking. Some fell on to the carpet and he
quickly gathered them up again. He was so pleased with his efforts.
In my notes I commented: ‘I was mindful of the need to provide safe
conditions for Chris, who could sometimes do the unexpected, and that I had to
be focused at all times’. I also wanted to let Chris do as much of the baking as he
felt he could, while I maintained safe conditions. I let him switch on the oven but
I put in the buns and took them out when they were ready.

Oaklander (1988) refers to work by Stevens (1971) describing fantasies that


can be used in conjunction with drawing. One of these is the rose bush.
Oaklander (1988: 33) says:

I will ask the children to close their eyes and go into their space and imagine that
they are rose bushes. When I do this kind of fantasy with children, I do a lot of
prompting – I give a lot of suggestions and possibilities. I find that children, espe-
cially children who are defensive and often constricted, need these suggestions to
open themselves up to creative association. They will pick that suggestion which
most fits with them, or will realize that they can think of many other possibilities.

I had been working with Tamsin (aged 14) for about a year when one day she
came for her appointment in a state of anger and frustration. I had experienced
this before with Tamsin, but on this particular day, these feelings seemed stronger
than usual. Partly to give her an opportunity to give expression to her feelings –
which she normally found it hard to do – I suggested she might do a rose bush
visualisation. Tamsin seemed keen to do this and produced the drawing (see
Figure 9.7 (i)), to which she then spoke her feelings of aloneness, confusion,
unhappiness and struggle to say how she felt.
One week later when I saw her again, I invited her to do another rose bush
that, to her surprise, was markedly different (Figure 9.7 (ii)).

(Continued)

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136  Person-centred Therapy with Children and Young People

(Continued)

Figures 9.7(i) and (ii)  R


 ose Bush – two drawings done one week apart,
show how some aspects of Tamsin’s life had
altered but others remained much the same

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Play, Materials and Dialogue in Therapy  137

Tamsin identified with happiness, she no longer felt so alone but was cautious
about being with friends. She was less difficult to talk to but she continued to feel
hurt and confused (as shown by petals on the ground and long, tangled roots).

Visualisations – I invited Martha (aged 18) to draw her rose bush, but first she
wondered what size this should be. I said she could decide. Martha did her
drawing in black pen, during which she would stop to think about her picture.
When this was finished I invited Martha to talk to me about her picture. She
described her drawing quite superficially and I then said how I felt her rose
seemed to represent three stages in her life so far: her childhood (roots), growing
up (stem) and as Martha seemed now (flowers).
Martha then talked about the stem drawn in a way that could be viewed as a
road or path. For her, this represented her journey to where she was now and that
the prominent thorns reflected something of the problems she had encountered
along the way.
My process notes recorded: ‘I invited Martha to reflect on the session since I
felt it was appropriate to her increasing self-awareness. She expressed being
nervous at the outset but towards the end became calmer and more at ease.
Martha said she would not mind doing this sort of thing again.’

Poetry – Naomi (aged 13) arrived with a plaster on her lower left arm and wrist.
Thinking what she might do, Naomi decided to create a poem describing her
feelings today using a magnetic board and words. She worked on this with great
care and produced a poem that she then read to me. Naomi made a few changes
and I then read the revised version to her.
When her father returned at the close of the session, Naomi expressed her
frustration with things that were due to arise in the coming weeks – moving house
and having to start at a new school.
My process notes reflected on the session: ‘Naomi was at ease today in the session
and we talked as she “wrote” her poem. When her father came to collect Naomi, her
expression of feelings was unexpected: it was as if his responses could not
acknowledge how she felt. Naomi seemed to want her father to hear what she had
to say and that doing so in front of me provided her with a relative sense of safety.’

Dramatic play – Talking about what had taken place since the last session, Will
(aged 14) spoke about his exclusion from school following an incident with a
peer. As in previous sessions, he was not sure what he would like to do and I

(Continued)

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138  Person-centred Therapy with Children and Young People

(Continued)
suggested that perhaps we might think about something around the school
incident. Will agreed to this and I invited him to describe what took place, with
me taking the role of the other boy. We recreated the event step by step, building
up each ‘layer’ of the episode. At each stage, I invited Will to suggest other ways
in which he might have responded and together we explored individual
responsibilities – his own responsibilities and those of the other boy.
My notes expressed the following reflections: ‘Will was committed to the
process of this session and could, for instance, recognise there are different ways
of perceiving right and wrong. It seemed to become apparent to him that in
difficult situations he is able to make choices and respond in ways appropriate to
the circumstances.’

Cartoon drawing – When I arrived at a temporary ‘outpost’ today, I was met by


Ian (aged 10) and his mother. She told me that since the last session Ian had
become angry with her and made to strike her but stopped just in time. She told
me he had been involved in a fight at school, for which both he and the other
boy were suspended.
When she left and Ian and I went to the room we normally used, I invited him
to tell me about the last couple of weeks since we had last met. Ian said he had
hit a boy who called his mother a bad name and had made him angry. I knew
Ian was protective of his mother in the light of difficulties his mother had
encountered in the last couple of years. I suggested we might perhaps do some
work on one of the episodes mentioned by his mother and Ian decided on the
school fight. The idea of a comic strip drawing came to mind and I folded an A3
piece of paper into six equal areas providing the basis of a comic strip. I invited
Ian to draw what had happened describing:
•• where the event occurred (at school)
•• what occurred before the incident (moving between classrooms)
•• what or who caused the problem (the boy making unwelcome remarks)
•• what took place (the fight)
•• the outcome (suspension).
When Ian completed this part of the drawing, I asked him to draw an alternative
ending in the sixth ‘box’. His drawing depicted an image of him walking away
from the other child without hitting out.
My notes recorded the session: ‘In the moment of listening to Ian, I thought
cartoon drawing might be a helpful way for him to break down the event into clearer
segments he might then look at individually. His alternative ending permitted Ian to
reflect on his actions and to work out another way of dealing with the situation he
encountered. Ian was attentive today and readily engaged with the task with humour
and insight. It is evident that Ian understands that certain actions are unacceptable
and he can make decisions as to his intentions when conditions permit.’

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Play, Materials and Dialogue in Therapy  139

Informal play – Sally (aged 3) seems constantly to be in conflict with her mother,
who recognises that she can be quite controlling and seeks to deny Sally self-
expression, which Sally rails against. This causes strong angry feelings for her
mother and serves to impose further strain on their relational state. I had
previously done extensive work with Sally’s mother.
On this particular day, Sally settled down to play with the Lego while her
mother stayed in an adjacent room. She decided to do a person. She then chose
to play with the farm set, involving me in moving animals around. Sally found a
puppet for me to use that she named Pierre. Sally fed Pierre ‘food’ from the farm
and then wanted to play the sleeping game we had played before, each taking it
in turns to be ‘asleep’. Having done this physical game, Sally decided to do some
printing and printed two pictures for her mother. I inked the printing stamps and
Sally produced the pictures.
My notes on the session read: ‘The session went well. Sally decided what
she wanted to do and controlled my role in the session. She seems
particularly pleased when I match her feelings – for instance, when pressing
down with the print stamp I would make a grunting noise to reflect the
pressure she was applying. Sally seems to value physical contact that is the
basis of the sleeping game. Her ‘blackbird’ would wake me with a tummy
tickle and then mine would do the same. It is some while since we last met,
and Sally worked through all the activities we had done before as if this was
necessary for her to re-establish elements of our relationship. Sally was
confident and readily engaged with me. She did not ask where her mother
was until the end of the session. I counted down the time and Sally kept to
the time boundary.’

Dialogue – Dialogue can at times be the preferred means of communication


for a relatively young child, as demonstrated by Hannah (aged 10), who had
come straight from school. She immediately spoke about her anger and it was
worrying her. We explored what it is that makes her feel that way. Hannah
said she did not know what triggered it but felt she could do nothing about it.
We talked around a few ideas before emerging with something that might
work. It might be helpful if Hannah could keep a record of times when she
experienced these feelings, what might have caused the feelings (if she knew)
and how bad the feelings were. Hannah designed a chart for the next two-
week period and said she would bring the ‘results’ to our next session so we
could talk about it.
My notes recorded the following comments: ‘Hannah is frightened that her
feelings are out of her control. I sense she is experiencing a stressful time, partly
because she starts a new school in September and it is also when her father
remarries – she will be a bridesmaid. I am also aware that Hannah is taking some
responsibility for her mother’s feelings and is struggling to avoid upsetting her
mother, even though her mother is acknowledged to be contributing to Hannah’s
anxiety at this time.’

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140  Person-centred Therapy with Children and Young People

Exercise

Reflecting upon each of the above session records, identify your detailed feelings
about the process described. Prepare a list of five activities and/or materials that
you would feel comfortable making available to a new client and describe how
they might be used. Consider how you might feel about introducing a ‘new’
activity to a play therapy session.

Summary
This chapter describes the nature of conversation in child-centred therapy
and seeks to explain why dialogue with children and young people can chal-
lenge practitioners not used to working with this age group. Some children
may adopt a dual process in which they talk to the therapist and engage in
an activity, sometimes doing both simultaneously. Acknowledging the pro-
vision of specialised therapies, including art, sand tray, music and drama, it
is also possible for generic therapists to safely offer certain of these activities –
depending upon their interest and experience – at an appropriate level
within a child-centred context. Other activities may also form part of the
therapist’s palette. Symbolism and archetypes integral to child-centred
therapy have a place in communication by children and young people.
The play space and facilities are explored. It is suggested that gradually
building up equipment and materials will aid the practitioner in gaining
confidence with the ‘tools’ provided and in seeking to match provision with
environmental practicalities.

Suggested further reading

Chasen, L. R. (2011). Social Skills, Emotional Growth and Drama Therapy. London and
New York: Jessica Kingsley Publishers.
Cirlot, J. E. (1971). A Dictionary of Symbols. London: Taylor and Francis.
Homeyer, L. E. and Sweeney, D. S. (2011). Sandtray Therapy: A Practical Manual. New York:
Brunner-Routledge.
Kramer, E. (2000). Art as Therapy: Collected Papers. London and New York: Jessica
Kingsley Publishers.
Lacher, D., Nichols, T. and May, J. C. (2005). Connecting with Kids through Stories.
London: Jessica Kingsley Publishers.
Schroder, D. (2005). Little Windows into Art Therapy. London and New York: Jessica
Kingsley Publishers.
Silverstone, L. (1997). Art Therapy: The Person-Centred Way. Art and the Development
of the Person. London: Jessica Kingsley Publishers.
Souter-Anderson, L. (2010). Touching Clay, Touching What? The Use of Clay in Therapy.
Bristol: Archive Publishing.

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Part II
Professional Issues

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10-Smyth_Ch-10.indd 142 19/01/2013 3:06:37 PM
10
Receiving Referrals and
Communications

Covered in this chapter:

•• Establishing effective practice


•• Clinical supervision
•• Intake assessment session
•• Medical history
•• Initial appointment with a child or young person
•• Parent–child relationships: communications
•• Providing refreshments
•• Record keeping

Establishing effective practice


Prior to receiving the initial enquiry about the provision of a child-centred
therapy service, substantial background work will ensure that the service is
ready and competent to effectively manage that enquiry. This chapter con-
cludes with suggested further reading, including a publication describing
systems and procedures needed for a therapy service. However much
research is undertaken before ‘going live’, the unexpected will always arise
and practitioners should endeavour to try to keep the unexpected to a man-
ageable minimum through the effective use of supervision.
In addition to seeking advice from the practitioners’ professional organi-
sation it is worth seeking practical guidance from an experienced child-
centred practitioner. Depending upon a practitioner’s background, it may
be helpful to undertake practice within an established organisation to gain

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144  Person-centred Therapy with Children and Young People

practical knowledge. An opportunity to ‘learn on the job’ in a competent


and supportive organisational structure is invaluable. The other point to
make is that, at all times, the overriding consideration is the maintenance of
safe practice. It is important that initial information is carefully assessed so
that the decision taken by practitioners as to whether the referral is within
their competence is the correct one. For financial or other reasons, it may be
tempting to accept referrals beyond the immediate scope of a practitioner’s
experience. It is also possible that an individual referral may become more
complicated than was initially apparent. Accepting clients as a new profes-
sional should be subjected to careful reflection and supervisory support. I
earlier mentioned that we should not expect to ‘hit the ground running’ and
I make no apology for reiterating this point. As therapists, we will always
be learning but our practice provides the opportunity for incremental expe-
rience both to expand our knowledge and to broaden our capacity slowly,
to increase the complexity of client work. Newly trained therapists are
advised against working with children outside the scope of their experi-
ence, such as those with intellectual difficulties and children with psycho-
logical disorders.

Exercise

You are considering the development of your practice to include working


with children and young people. Prepare a personal plan for the forthcoming
12 months that describes what you will need to achieve in order to get that
practice up and running. How will this plan provide for you to gain
experience and confidence with the appropriate age group?

Clinical supervision
Professional counselling and psychotherapy organisations stipulate supervi-
sion as mandatory. Supervision is described by Agee (2003: 170) as:

A confidential relationship designed to monitor the safety and effectiveness of the


counsellor’s practice, and to provide personal support for the counsellor. It is a
source of on-going professional development, where counsellors can monitor
both the maintenance of objectivity and their personal involvement in counsel-
ling relationships.

Practitioners are generally obliged to receive supervision support inde-


pendently of all management relationships. When supervision and
management are provided in-house (such as in a school), the role of an
independent supervisor is widely considered necessary for the promo-
tion of sound ethical practice.

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Receiving Referrals and Communications  145

Supervision is essential for maintaining the professional conduct of


counsellors, for helping them to examine their own feelings of counter-
transference, providing a quality service to clients. Supervision seeks to ensure
ethical practice in both protecting the client and supporting the counsellor,
at revealing blind spots and the sense of being stuck in the therapeutic
process, and at exploring the counsellor’s sense of self in the relation-
ship. Supervision is an exposure of information shared in confidence
since the process cannot be conducted without partial disclosure of a
client’s material.
Dispenser (2011: 3) says: ‘It may be difficult to work with a supervisor who
comes from a very different theoretical background or professional training’
and ‘[t]he less experience the therapist has, the more experience the supervi-
sor should have’. Mearns (2008: 1) describes counselling supervision as
‘based on a “developmental” rather than a “deficiency” model of the per-
son’. Supervision aims ‘to develop a relationship in which your supervisor
is regarded as a trusted colleague who can help you to reflect on all dimen-
sions of your practice and, through that process, to develop your counselling
role’ (Mearns, 2008: 1). Supervision is not optional and is a vital part of the
healthy and ethical practitioner. Looking at one professional organisation,
the minimum supervision requirement for an accredited practitioner is 1.5
hours a month, but this is ‘relevant only to the most favourable of circum-
stances for an experienced, well-trained counsellor engaged on a relatively
light counselling load with a clientele that is not especially demanding’
(Mearns, 2008: 2).

Exercise

Professional clinical supervision is a mandatory requirement of the professional


counselling and psychotherapy organisations. You are employed as a child-
centred practitioner in a social services organisation providing in-house supervision
through your line manager. Describe the limitations and benefits of such supervision
arrangements.

Intake assessment session


In private practice, the primary source of new referrals for me is a child’s
parents, although I occasionally receive referrals directly from others, such
as general medical practitioners and social workers. My first point of contact
is usually a parent, who gives me a short description of what may have led
to their calling me. From the outset, I respond to the enquiry with confidence
and, not infrequently, offer reassurance, if appropriate. It is also possible
that, at this early stage, I will decide not to proceed further if, for instance, a

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146  Person-centred Therapy with Children and Young People

parent is seeking a formal diagnosis of ADHD that requires referral to a


medical specialist. I seek to redirect enquiries whenever possible.
The intake session is of particular importance because, having taken a full
history, I will have a reasonably clear understanding of the presenting cir-
cumstances. It is also the point at which I will make a decision about whether
or not it is appropriate for me to meet with the child. While Chapter 4
describes the formative relationship between the practitioner and parents/
guardians, there are occasions when I will decide not to continue with a
referral. These include:

• • The need to exclude possible psychological and/or physical problems prior to


therapy commencing. General medical practitioners will, in appropriate
cases, arrange investigations to exclude physical symptoms before indicating
a possible cause as being psychological. In the same way, parents might
attribute a child’s presenting behaviour with a psychological or emotional
condition when, in reality, there may be undiagnosed physical symptoms.
Enuresis (bedwetting), for example, may have a medical, social or psychological
cause such as constipation, kidney disease, cystitis, diabetes mellitus,
sensitivity to certain food or food additives as well as emotional problems at
school or at home. Occasionally, practitioners might – through the particular
nature of the therapeutic relationship – identify a potential physical or
intellectual difficulty that should then be reviewed by the appropriate
professional.
•• Circumstances in which a child’s difficulty substantially involves other family
members or social circumstances, including indications that family members, the
school or other involved adults might undermine individual therapy (Reisman,
1973). There are occasions when – intentionally or otherwise – a child may find
him/herself targeted as the source of a family’s difficulties. For example, if a child
refuses to attend school, it inevitably imposes a strain on other aspects of the
family’s relationships. This can generate pressures and disrupt the stability of other
family members, such as a parent who is unable to attend work regularly because
of that child. Superficially, the answer to the problem might be straightforward: if
only that child would go to school then the pressure would be eased. Looking below
the surface, another perspective might be found. What if the child is anxious or
distressed because that parent is struggling at work due to threatened changes, such
as redundancy? Is it possible that the child has become adversely affected by that
parent’s own worries about what the future may hold and is treating those anxieties
as his/her own? Pincus and Minahan (1973) suggest that sometimes someone or
something other than the troubled child can more appropriately be the target of
intervention.
•• Occasions when another professional agency is already involved (or is about to
become involved) in providing specific support to a child. In these instances,
declining the referral may minimise confusion and conflict. With parental
permission, direct contact with the agency may enable the practitioner to establish
if his/her participation may be complementary or possibly conflicting.
•• When I feel that therapy would not benefit a child’s overall well-being. This might
arise when a parent, who would clearly benefit from help, insists that I see his/her
child instead. An emotionally healthy parent can do more to support their child on
a daily basis than therapy can offer.

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Receiving Referrals and Communications  147

Exercise

Reflecting upon your professional experience, what kind of referrals might you feel
comfortable about accepting? Identify the kind of work you would contemplate
deferring until you have further training and/or experience.

Medical history
I want to focus on medical history for a moment. Although it may not at first
seem relevant to child-centred therapy, my experience indicates that practition-
ers should be mindful of this factor in understanding a child’s background.

I recall working with an 8 year-old girl (Jade) who occasionally displayed attitudes
at home such as ignoring her parents when asked a question. They considered her
behaviour unacceptable and she would at times become quite moody. During the
third session I noticed that when Jade had her back to me, she did not seem to
hear what I was saying. Initially, I wondered if Jade was so focused on her activity
that she forgot I was there, but another possibility occurred to me. Was it possible
she had a hearing difficulty of some kind? At a review appointment I spoke to
Jade’s parents about my feelings and advised them to talk to her GP.

Amelia (aged 10) and in the last year of primary school occasionally got into trou-
ble with teachers because she seemed to ask so many questions that they thought
she was ‘attention seeking’. That was not the reason for her referral to me but as I
came to know her I felt there might be an alternative explanation. When Amelia
asked me about a subject, the supplementary questions seemed to become
increasingly detailed and I found this unusual, although I also felt a strong desire
on Amelia’s part to try to understand the subject she was exploring. I spoke about
this at a multidisciplinary meeting at Amelia’s school and a decision was taken to
refer her to a speech and language therapist. This assessment revealed that she had
language difficulties affecting both her receptive and expressive language skills.
Teachers were made aware of the assessment and provisions were put in place to
support Amelia. (See Chapter 12 on multidisciplinary practice.)

Initial appointment with a child or young person


Chapter 1 described my initial meeting with a child client. When I meet that
child for the first time with a view to offering therapy, I will by then have a
good idea of him/her – at least from a parental viewpoint. I do not repeat
any particular detail given to me at intake other than perhaps touching upon

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148  Person-centred Therapy with Children and Young People

the child’s prominent feelings that might have initiated the referral. For
example, I might say, ‘Your Mum and Dad told me that you’ve been having
a difficult time at school lately and that this has made you feel sad’. These
initial appointments are not without their risks: the practitioner seeking to
make a good impression may be anxious at the prospect of ‘shifting’ from
adult to child mode; the child may be worried and have little idea of what to
expect. Putting a child at relative ease can also be problematic for the unwary
therapist, perhaps trying to ‘sell’ the therapy or patronising the child with-
out even realising it.
Some children make out that they understand what is being said when
they show non-verbal signs to the contrary. Once in a while, parents at intake
may tell me how bright their child is and how quickly they will be able to
absorb information about the way I work. With this information in mind, I
may then sometimes find that when I meet the child I pitch my description
at an inappropriate level and suffer the consequent embarrassment. Never-
theless, I prefer to do this since I might otherwise be tempted to form a
judgement about the capacity of my client either to understand or be inter-
ested in my explanation of the therapeutic model. If, inadvertently, I use a
word with which a child may be unfamiliar, I will encourage that child to
intervene and ask me to explain. I do not regard this as a shortcoming of the
child’s ability to comprehend what I am saying but, rather, a failing on my
part to be clear.
With a teenage client, I may have very little background information and
when I first meet my client I do not routinely provide an intake process.
Instead I may ask such clients what has brought them to meet with me and,
if they wish to proceed, what they might like to gain from therapy. Over a
number of sessions I will accumulate strands of information from my client’s
perspective. Slowly I may form a picture not only providing a statement of,
say, family relationships, but also affording me an emotional context for that
individual’s circumstances.
I have described two different information-gathering systems and both
are respectful of the child-centred approach to therapy. I feel that, in an effort
to be truly equal in the relationship, many more risks are to be encountered
in the first meeting with a child than with a teenage client. The key variation
is that additional measures are necessary to ensure that young children are
appropriately supported, even though the information gained may not come
from the child – thus normally precluding its use within the therapeutic
relationship.

Exercise

As a young person of 14 years of age, your mother talks to you about getting some
outside help with your lack of confidence and low sense of worth. You can accept
there might be some benefit in seeing someone but, at the same time, you are

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Receiving Referrals and Communications  149

quite anxious at the prospect of meeting this adult for the first time. Record your
feelings about preparing for that first meeting and work out if you would first like
your parents to have a meeting with the therapist or whether you want to do this
independently without their direct participation. Describe the benefits of going to
an initial meeting on your own and also identify the advantages of your parents
having an intake session with the practitioner.

Rogers (1939: 287) offers an insight into the mind of a child who is consid-
ered in need of therapeutic support:

It is quite probable that he has been threatened with being ‘sent to a doctor,’ or
‘sent to the school adviser’ by parents, teachers or others. It is highly probable
that he has found adults more ready to criticize and pass judgement than to be
understanding and noncritical. Hence the therapist will do well to allow the
relationship to develop somewhat slowly, and to recognize frankly and verbally
the child’s skeptical reactions to the situation.

Again, he states:

In psychotherapy the aim is to leave the major responsibilities in the hands of


the child as an individual growing toward independence. The more this is and
can be done, the more lasting and effective the treatment. It cannot be accom-
plished at all unless the therapist has the capacity to see the child as a separate
individual, who has both a right and obligation to maintain his separateness.
(1939: 282–3)

Exercise

Consider how you would help a child meeting you for the first time to feel
comfortable with you. What would you do or how would you be able,
successfully, to enable that child to feel special and valued by you?

Parent–child relationships: communications


Developing and maintaining an effective relationship with a child’s signifi-
cant adults (usually parents) cannot be underestimated, for reasons explained
in Chapter 4. I am aware that despite all the good that parents are doing for
their child, something appears to them not to be working. They may feel that
since they are seeking therapy for their son or daughter, they have somehow
failed as parents. I believe it is from a position of genuine concern and
strength that parents may look externally for support. I do not underestimate
the trust they are investing in me to help their child. If I am to be able to form

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150  Person-centred Therapy with Children and Young People

a relationship with that child, it is essential I first gain parental trust. I am


comfortable when my relationship with parents is one of mutuality. Not only
do I develop a relationship with my child client, but I also aim for a worth-
while relationship (albeit indirectly therapeutic) with the child’s parents.
Understanding the attitudes of parents towards their child can assist the
practitioner’s overview of the child within the family context. My experience
enables me to sense what might usually be encountered at various phases of
development and growth and, as Rogers (1939: 187) comments, ‘Parents may
respond to information of a general nature, such as a description of the com-
mon traits and difficulties to be anticipated in adolescence, or to very specific
instruction, such as the suggestion of a specific method of giving an allow-
ance’. In common with Rogers, I have generally found my suggestions in
relation to home responsibilities for the child are well received. Moreover,
parents ‘with a child of a certain age may be helped by a description of the
normal degree of independent behavior achieved by the average child of that
age’ (Rogers, 1939: 187). It also happens that some parents may unwittingly
make unreasonable comparisons among their children. Supporting their
efforts to acknowledge the uniqueness of each sibling may in turn positively
influence the parental acknowledgement of their children as individuals.
Working with a child or young person will invariably involve some
engagement with parents, although it would not be described as family
therapy per se. I know that when parents are ‘on board’ with the provision of
therapy for their child, it can provide a worthwhile opportunity for encour-
aging positive shifts in the child–parent relationship. When this is possible,
the rewards for the family can be substantial, but there are times when the
process seems to work not so well.

For instance, Martin (aged 9) often seemed to encounter problems at home with
his brother, who is 14 years old. The brothers frequently argued and their parents
found it hard to implement and maintain suitable boundaries of care and behav-
iour. It was apparent to me that Martin was invariably confused and uncertain
about what was expected of him at home. Over time I felt Martin’s father could
bring about a sustainable improvement in the family’s emotional dynamic. When
I explored this with Martin’s father, he spoke about his own upbringing and belief
that his parents’ approach was also appropriate for his children. He felt his par-
ents’ love for him was unconditional and deeply caring, but I felt that the bound-
aries he described were inconsistent and confusing. I suggested to Martin’s father
that he might consider doing some personal work but he gently ignored this.

Landreth (2001: 92–3) comments:

Sometimes parents may have personal problems that interfere with their ability to
interact appropriately with their child. In this case, if the problems are mild, the
therapist may wish to do personal counseling with one of the parents by meeting
with the parent at a time other than the child’s scheduled session.

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Receiving Referrals and Communications  151

Rogers says: ‘If a parent is given information which runs strongly counter
to his own emotionally determined attitudes, he will not only reject the
information but may reject the worker as well’ (1939: 189). In this particular
example, Martin’s father continued to be supportive, if at times on the margins,
of his son’s therapy.
Consultation with parents can lead to a change in their attitude about the
child and offer them an insight into the child’s feelings and perceptions. In
addition, working with parents can improve their communication and
skills, thus enhancing parent–child relationships. Practitioners need to
maintain the confidentiality of the therapeutic session, but Landreth (2001: 91)
cautions: ‘When providing the parents with information about the child’s
sessions, the therapist must assess the parents’ ability to accept the informa-
tion appropriately, the contents of the information, the vulnerability of the
child, and the safety of the parents and the child.’

Exercise

What do you feel are the merits of involving parents in their child’s play therapy
support? Are there circumstances in which you believe they should not participate
in the process? Describe in detail your feelings about both of these questions.

Providing refreshments
As part of the intake session before meeting with a new client, I find out from
parents if there are any dietary restrictions since I will usually offer refreshments
to children and young people in my private practice. Sometimes children come
straight from school and/or have travelled a significant distance to get to the
appointment. When a practitioner chooses to offer refreshments it is important
that any allergies or other adverse reactions are known beforehand. While chil-
dren are usually well versed in the requirements of their condition, it is appro-
priate to check with the parents directly. On one occasion I did some work with
a young girl who had a high intolerance to nuts, which, if consumed, could
rapidly induce anaphylaxis. Although her parents showed me how to use their
daughter’s preloaded adrenaline auto-injector, I took care not to supply any
biscuits at all thus avoiding potential paramedical intervention.
I also take precautions in relation to children with diabetes mellitus by
familiarising myself with their needs should an urgent situation arise. Par-
ents will provide emergency rations to deal with acute hypoglycaemia. I
further ensure I have a parent’s emergency contact number readily available
should this be needed. If I feel uncomfortable in dealing with situations such
as a child with poorly controlled diabetes or a propensity for major acute
anxiety episodes, then I would want a parent to remain nearby during the
therapeutic session.

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152  Person-centred Therapy with Children and Young People

Record keeping
Therapists have a responsibility to maintain records of an acceptable profes-
sional standard. From a child-centred perspective, I do not make notes dur-
ing a client session since I feel my focus should be on the client. Taking notes
is an unacceptable intrusion, detracting from being fully present for the
child. There are also ethical and legal provisions concerning records and
their security, which are described in Chapter 13.
Record-keeping provisions may vary from one setting to another and
practitioners will need to maintain their records in accordance with the
policy for that setting. In general, the format of recording one-to-one play
therapy sessions will include:

•• Client identification reference (a reference avoids using names and aids


confidentiality)
•• Date, time, number and venue of session
•• Session process notes – including interactions (verbal and non-verbal) equipment/
materials used, new relevant information, development of themes
•• Feelings of therapist about the session
•• Personal reflection and matters for supervision (as appropriate).

(The vignettes in Chapter 9 utilised this form of recording.)

The recording process for one-to-one work with young people in which con-
versation is the primary form of communication has fewer ‘layers’. For
instance, equipment and materials are unlikely to be used and the develop-
ment of themes will be incorporated in the process narrative. With play
activities, the practitioner will be ‘in the moment’ and focused on the child,
interacting, being alert to the messages that play might be communicating
and maintaining safe boundaries. This can be likened to trying to keep a
number of plates simultaneously spinning, ensuring not one of them drops.
The general busyness of a play therapy session can involve the practitioner
so deeply that it is only afterwards that a theme for the session or an impor-
tant message conveyed by the child through play becomes apparent.
Accordingly, while the majority of notes will be recorded immediately fol-
lowing the session, the therapist’s feelings and personal reflection might
sometimes be appropriately left for 24 hours. I have found that a time lapse
can provide me with a clearer context for significant play than may be pos-
sible immediately after the appointment.

Summary
This chapter describes some of the key professional considerations for devel-
oping an effective child-centred practice. It explores ways of developing
experience and emphasises the importance of providing suitable professional

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Receiving Referrals and Communications  153

support. Safe practice involves practitioners identifying their initial limits of


personal and professional experience, and acknowledging an individual’s
capacity to build incrementally upon that initial experience.
The process for receiving enquiries and referrals needs to be carefully
thought out and will vary according to the setting in which child-centred
therapy is provided. Many organisations will have their own systems for
considering and accepting new referrals. The guidance offered here defines
the process from a private practice perspective and may include elements
that might be appropriate for application in other settings.
Establishing and maintaining effective communications with a client’s
parents is regarded as worthwhile and beneficial in the developing thera-
peutic relationship. Finally, the chapter offers practical advice on the provi-
sion of refreshments to young clients and describes the recording of play
therapy sessions.

Suggested further reading

Boy, A. V. and Pine, G. J. (1999). A Person-Centered Foundation for Counseling and


Psychotherapy. Springfield, IL: Charles C. Thomas.
Hornby, G., Hall, C. and Hall, E. (eds) (2003). Counselling Pupils in School: Skills and
Strategies for Teachers. London: Routledge Falmer.
McMahon, G., Palmer, S. and Wilding, C. (2005). The Essential Skills for Setting Up a
Counselling and Psychotherapy Practice. New York: Brunner-Routledge.
Palmer, S. and Bor, R. (2008). The Practitioner’s Handbook: A Guide for Counsellors,
Psychotherapists and Counselling Psychologists. London: Sage.

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11
Boundaries in Child-centred Therapy

Covered in this chapter:

•• Introduction
•• The distinct nature of boundaries in child-centred therapy
{{ General
{{ Confidentiality
{{ Limits that nurture and facilitate

{{ The practitioner’s role

{{ Sexual abuse

•• Testing the therapist


•• Revisiting therapist omissions
•• The constraints of time-limited therapy
•• Ending a session

Introduction
This chapter focuses on establishing and maintaining boundaries in child-
centred therapy where, for instance, aggressive acting-out behaviours may
occur. In counselling therapy, an angry teenager will normally articulate
his/her feelings through verbal expression or another modulated manner
concomitant with the adult–practitioner relationship. Young children, on
the other hand, may use play to express feelings in a way that can be both
visual and physical.
Practitioners can be faced with unknown and complex challenges from young
children, particularly in setting boundaries, than those prevailing in working
with teenagers and adults. The nature of boundary setting with young children
is multidimensional and can present practitioners with difficult dilemmas to

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Boundaries in Child-centred Therapy  155

‘hold’ within the session. Setting boundaries might perhaps be equated with the
notion of the therapist applying controls and constraining the actions and behav-
iours of children. If that were the case, it would be inconsistent with the values of
child-centred practitioners. Harris and Landreth (2001: 28) say: ‘The wise thera-
pist knows that appropriate limits must be set because they provide the child
with the security necessary for satisfactory therapy to take place.’ They go on:
‘The limits the therapist sets are few in number and provide a clear definition of
acceptable and unacceptable behaviour.’ While the practitioner must provide a
safe environment for a child’s exploration, it is also essential that, within the
limits of their capability, children are able to acknowledge their responsibility to
the practitioner, hence my mantra: ‘You look after me and I’ll look after you.’
In my early professional practice I was acutely aware that boundaries in
child-centred therapy often presented me with personal challenges. I strug-
gled to strike a balance between, on the one hand, being open and accepting
and, on the other, feeling undermined and out of control. I did not feel this
when alone with my client, but problems could arise when a parent was pre-
sent. It was not unusual to experience a sudden change of relational atmos-
phere when a parent arrived to collect their child. During one session, for
instance, I would have been content for that child to vault over the sofa. As
soon as mother or father appeared in the counselling room to meet their son
or daughter, the parent would immediately take control and admonish their
child for clambering over that same sofa. However I tried to reason with
myself, I felt uncomfortable and appeared to others as if I could not ‘control’
my client. While I wanted to say, ‘Hang on a minute, this is my room and it
is OK with me if he/she wants to do this’, I would say nothing.

Adrian, a 12 year-old, invariably took off his shoes when he arrived in the counsel-
ling room. On one occasion at the end of his session I left the room for a moment
to fetch his mother. Although, technically, the session had finished, Adrian contin-
ued playing and as soon as his mother came into the room she ordered him to put
on his shoes and castigated him for not first undoing the laces. My immediate incli-
nation was to jump to Adrian’s defence, but I felt that would be inappropriate so,
rather than support Adrian, I felt I had undermined him. It took me a while to work
out that I was the ‘problem’. I failed to maintain the boundary marking the ‘space’
between the end of the session and the physical arrival in the room of my client’s
parent. It was indeed my responsibility to ‘manage’ this transition but the physical
layout of my counselling space made this more difficult – or so it seemed to me.

Jennings (1999) remarks that Lowenfeld was very strict about the playrooms
being only for the children and the therapists. When I first began to work in play
therapy I appreciate that, had I then implemented Lowenfeld’s policy, sessions
might have proceeded more efficiently. While I would support her statement, I
also recognise that there will be occasions when – to facilitate the early sessions
with a new young client – it may be appropriate for a client to have a parent
with them. Although parental presence can inhibit the therapeutic relationship,

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156  Person-centred Therapy with Children and Young People

I tend to regard these initial sessions almost as analogous to pre-therapy (Chap-


ter 7), when I experience that the presence of a parent is facilitative to a child’s
initial therapeutic process.
When agreeing to a parent being present in the early stages of the thera-
peutic relationship, the practitioner explains that, progressively, the parent
will withdraw from sessions. Initially the parent might wait in a nearby
space so that, if necessary, the child is able to ‘check-in’ with that person, but
within a few sessions it will normally be possible for a child to indepen-
dently manage the therapeutic relationship. If this gradual ‘moving away’ of
the parent from the child is difficult to sustain for the entire counselling ses-
sion, the practitioner should explore this with both the parent and child, as
appropriate – separately if necessary. It can be indicative of anxiety separa-
tion either on the part of the child or indeed the parent or both. It can be
difficult to establish whether the origins of the separation anxiety lie with the
parent or the child. Even quite young children may believe a parent’s pres-
ence is capable of placating that parent’s troubled feelings and that while
they are in the near vicinity, all will be well. A parent and child can become
dependent upon each other’s presence for security.
Other contributing information guiding the practitioner might, for exam-
ple, include irregular school attendance, but while each ‘strand’ of informa-
tion may collectively contribute to a clearer understanding of what may be
happening, in isolation, each element can have a variety of possibilities.

Exercise

What is your view on parents being permitted in the playroom? Whether or not
you have a strict policy, describe in some detail the benefits and drawbacks of
your preferred position.

The distinct nature of boundaries in child-centred


therapy
General
The consistency of boundaries is important, particularly where parents may
be inconsistent in implementing family rules, which causes confusion and
doubt. Therapeutic relationships providing consistency for children will also
enhance their emotional security and permit them an opportunity to gain
experience of such a relationship. Axline (1947: 132) says:

It is important that the limitations once agreed upon should be consistently fol-
lowed. Consistency in the playroom is just as vital as consistency in any other
relationship. It is the element of consistency that provides the child with a feeling

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Boundaries in Child-centred Therapy  157

of security. The consistency demonstrated by the therapist assures the child of his
acceptance. The consistency of the permissiveness in the situation determines the
depths to which the child can go in expressing his feelings.

Meeting a prospective client for the first time, I will say that I have only
one important rule – the mantra (p. 155). Having this ‘umbrella’ avoids
introducing new, more explicit rules as the relationship develops. Children
can become frustrated and feel let down when they believe they are
working to the established rules only to discover that they suddenly
seem to change, as if the ‘goalposts’ are unexpectedly moved. Axline
(1947: 133) says:

Care should be taken not to confuse a limitation with the pressure device. There
is no desire on the part of the non-directive therapist to exert pressure to bring
about change in the child. Any change that is worthwhile comes from within the
child. Therefore, the therapist guards against using a limitation to bring a problem
into focus. For example, a child who has become a non-talker is never told that
he must talk when he comes into the room.

Confidentiality
Confidentiality is of course a substantial boundary that the practitioner has
to maintain in any client work (see Chapter 4). However, the exclusion of
parents from even the periphery of the therapeutic relationship can lead to
parental isolation and loss of trust. Any parent entrusting their child to the
‘care’ of a child-centred therapist takes a huge step in the interests of that
child. Aside from the needs of medical treatment, there are few other circum-
stances in which such a deep and wide-ranging sense of trust is sought in a
child’s one-to-one relationship with an adult. Landreth (1991: 91) says: ‘After
the initial session, parents can continue to be involved in the process of
therapy through parent consultation, individual counselling for one or both
parents.’ He maintains that the aims of parental participation are to increase
the effectiveness of parents in meeting the emotional needs of their child and
to facilitate the growth of that child.
Consultation can also provide parents with an insight into their child’s
feelings and perceptions. This constitutes an important component of the
parental review following each set of six sessions in relation to children aged
12 or under. Occasionally I may undertake review appointments with the
parents of slightly older children if I feel this would be appropriate. In
advance of the review date, I remind my client of the review and will find
out if he/she would like to be present. Invariably children prefer not to
attend but it is important they have the opportunity to do so. I also find out
if they are content for me to represent their interests at the review session
and find out if they would like me to represent any particular points.
Equally, I want to understand what matters, if any, they wish me not to men-
tion. I explain that in relation to drawings and other material they have

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158  Person-centred Therapy with Children and Young People

produced, I would like to be able to show examples to their parents, but only
if I have their agreement to do so.
I have found this process to be effective and a satisfactory way to include
parents in the therapeutic relationship. By the time of the first parental
review, clients will have worked with me on at least six occasions and, hav-
ing reached this stage in the relationship, a significant level of trust is pos-
sible. Once completed, my next session with clients will include review
feedback and discussion of any relevant points mentioned. I also invite cli-
ents to let me know if there is anything from the review that parents may
have spoken about to them that they would like me to clarify.
Unusual situations need to be resolved with parents and/or the client. For
instance, if following a review, one parent wishes their child to continue with
therapy and the other does not want this to happen, then the practitioner
must address the difficulty. There are legal issues to consider (see Chapter 13)
and there will be occasions when advice must be sought, perhaps from the
practitioner’s professional insurer.

Limits that nurture and facilitate


According to Jennings (1999: 18), ‘[w]hat children need is a nurturing struc-
ture within which they are free to develop and explore and where certain
realistic borders are placed on their day-to-day activity’. Referring to the
absence of limits, West (1996: 175) says: ‘Children can feel scared if left
totally free, particularly those with poor differentiation between themselves
and other people, and children who can become violent and “act out”.’
Harris and Landreth (2001: 28) observe: ‘Such limits anchor the child’s
therapy to the world of reality. The therapist is aware that limits are condu-
cive to developing self-discipline and hopes that the child will eventually set
limits for himself.’ It is important children can recognise that, while they
may experience the therapist as more permissive than life at home, the rela-
tionship is nonetheless real. Children who come to regard the therapeutic
relationship as a fantasy devoid of real-life constraints will be unlikely to
benefit appropriately from the therapeutic process. With quite young chil-
dren I may use the term ‘special playtime’ to convey the sense that these
conditions are specific to our therapy relationship and do not apply outside
the counselling room. In my child-centred practice, children do not need to
clear up at the conclusion of a session. I am only too aware that, at home,
children are generally expected to tidy up any mess. I can therefore imagine
the irritation of parents who might be told by their child, ‘My counsellor
doesn’t make me tidy up!’

The practitioner’s role


Therapists need to be firm but reasonable in the limits they set. The simple
mantra I have already described may need to be repeated to some children
who occasionally need reminding that their actions lie beyond ‘looking after

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Boundaries in Child-centred Therapy  159

me’. Invariably I might quietly ask them, ‘Do you remember the rule I men-
tioned to you when we first met?’ This is usually sufficient to restore balance
in the relationship.
Harris and Landreth again:

It is critical for the therapist to maintain neutrality while sympathetically reflect-


ing the child’s feelings. The therapist does not react to the child with irritation or
anger but sets limitations in an impersonal, non-punishing manner. The counselor
communicates limits decisively and seeks to convey the spirit of a non-punitive
helpful authority. (2001: 28–9)

Occasionally, a child’s actions can trigger a therapist to become intolerant,


leading to the loss of the therapist’s positive regard for that child. Albeit
momentary, such an intervention may damage the relationship the practi-
tioner has been seeking to establish. Therapists need to exercise tolerance to
ensure their personal considerations do not interfere with the child’s need to
be messy or ‘destructive’. ‘When children are able to symbolically express
their negative feelings, they are freed from potential anxiety or guilt over
actually harming someone or something’ (Landreth, 1991: 242).

Sexual abuse
Johnson and Clark (2001: 242) state, with particular reference to children
subjected to sexual abuse:

Limit setting is an area of particular concern when working with aggressive act-
ing-out children. The physical safety of the child, therapist, and the room must be
protected through appropriate limit setting. Through setting limits, the therapist is
able to preserve feelings of acceptance, empathy, and positive regard for the
aggressive acting-out child.

Ater (2001: 121) says: ‘Sexually abused children will test limits as well as
exhibit acting out behaviour during the session as their way of working
through trust issues with the therapist’ (see also Kelly, 1995). Sometimes
children’s feelings of being bad will show through in the therapy because
they feel they are to blame – that the abuse is their fault (Cattanach, 1992).
Practitioners receiving a referral in relation to a child who is known to have
been sexually abused and is coming to therapy in the light of that experience
will find it less challenging to maintain the therapeutic conditions. Where
sexual abuse is suspected but has not been established, these circumstances
can lead practitioners to lose sight of their primary objective – to maintain
the necessary therapeutic conditions. If sexual abuse is suspected, then the
details must be reported to the appropriate statutory authority without
delay. Practitioners must not attempt the dual role of establishing that sexual
abuse has taken place and, in the same context, offer therapy. Care must also
be taken not to assume that because a child appears to aggressively act out in
therapy, he/she has necessarily been sexually abused.

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160  Person-centred Therapy with Children and Young People

Testing the therapist


Johnson and Clark (2001) refer to testing the therapist and suggest that chil-
dren may do this subconsciously. The very nature of testing can sometimes
lead practitioners to feel it is both conscious and personal. A therapist caught
‘off-guard’ in these circumstances might struggle to be wholly accepting of
his/her client. Children discover that their testing behaviour is unacceptable
to adults in their lives and practitioners can feel pressured to react similarly.
Children will test the therapist so they can seek understanding for feelings
and emotions they find confusing outside therapy. They may push the limits
to see how far they can go before the practitioner intervenes, simply because
they may feel a lack of consistent interventions elsewhere (Figure 11.1).

Tom (aged 8) would constantly test me and even though I knew this seemed to be
largely due to the absence of a sound paternal structure, there were occasions
when I would feel challenged by him to the extent that I might sense a growing loss
of focus on my part. Prior to each session I anticipated that Tom would be likely to
test me and he did not disappoint. One day he tested me in a way for which I was
unprepared. Within a few minutes of the session starting, Tom rummaged through
my belongings, having not done so previously. Following this session I decided that
next time I would remove temptation from the counselling room and just before I
saw Tom the following week I did just that. When Tom arrived for his session and
looked around for my property, I told him that after the last session I felt it was bet-
ter that I removed my things and would continue to do so. He accepted this without
demur and while he moved on to test me in other ways, I was able to remain
consistent in my positive regard for him in our relationship.

Testing the Therapist – a child’s view of putting the therapist


Figure 11.1 
under pressure

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Boundaries in Child-centred Therapy  161

Cochran et al. (2010) describe circumstances in which a therapist may


avoid setting limits in the belief that conflict may be avoided or perhaps
because the therapist fears a negative reaction from a child. Experience will
enable practitioners to develop clarity for what needs to be off-limits and
apply acceptable limits with consistency. I feel that in early practice particu-
larly, therapists may expect to make mistakes in relation to boundaries. It is
important that practitioners can learn from those experiences through self-
reflection and/or supervision.
Axline (1947: 93) says:

From the beginning session, the therapist lets the child know that she respects his
ability to make his own decisions and she abides by that principle. Sometimes
this is the testing period on the part of the child. Children are skeptical of this
attitude of permissiveness at first. They test it out. The child who sits in idleness
may be testing out the therapist to see if she really meant what she said. Again,
that idleness may be resistance – passive resistance to the change someone is
trying to force upon him. The child resists all efforts to change him. If lack of
participation during the play hour expresses his resentment against outside pres-
sure, then it seems better to grant him the permissiveness to show his resentment
in that fashion.

Alex (aged 6) constantly challenged the boundaries of our sessions. At each ses-
sion he would test the limits (I felt) to gauge my reaction. Even though the activity
that gave rise to the test might vary from one session to the next, Alex continued
to experience the constancy of my boundaries. After some three months, Alex
increased the challenge by intensifying his behaviour, anticipating that I might
‘crack’ and get angry with him. On one occasion he threw a number of objects
on the floor and told me to pick them up and timed me while I did this. Having
collected all these objects he told me how long I had taken and then threw them
on the floor once again demanding that I retrieve them while he timed me.
Repeating this process Alex told me to collect the items but on this occasion I
simply said, ‘I don’t think I want to play that game any more’. The session then
moved on to a less testing activity. In time Alex accepted that the boundaries
were not going to be compromised and gradually diminished his need to test the
security of our relationship.

Exercise

Given that children and young people need boundaries in their lives, how would
you establish and maintain these in a therapeutic relationship? What circumstances
might challenge your ability to hold the boundaries and put you under personal
pressure?

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162  Person-centred Therapy with Children and Young People

Revisiting therapist omissions


The nature of therapy with young children is such that it is quite possible to
overlook something a child says or, more likely, does in a session that may
not immediately appear to be important to the practitioner. Reflecting on
each therapy session can reveal more than might have been apparent at the
time. It is as if, while engaged in the session, the practitioner ‘is in the
moment’ and therefore immersed in the process. Subsequent reflection can
identify noteworthy moments that may include something the practitioner
did not respond to appropriately. I consider these occasions – rare though
they may be – to have been the product of my oversight. When such a
moment arises I believe it is important to revisit this at the next session and
explain what happened. It conveys my deep regard for the child as well as
showing I have reflected with care on what took place at the session. More-
over, apologising for an ‘error’ or oversight rather than ignoring it, can
heighten the young client’s sense of feeling valued and, consequently, his/
her sense of participation in the therapeutic relationship can be enhanced.
No matter how experienced, child-centred therapists will from time to time
‘miss’ important material a child presents. I refer to children who may, within
a single session, repeat a particular element of play. Berry (1971: 326) remarks
that sometimes a particular piece of play may seem trivial but if it is repeated
several times (and children are known to re-present the material, perhaps
with minor variations), the therapist should examine it carefully to under-
stand what the child’s actions are communicating. Such repetition might not
be immediately apparent to the practitioner and only once it is explored –
perhaps through supervision – might the communication become clearer.
Repeated play, when a child engages in near identical play from one ses-
sion to the next, may indicate a child who remains troubled by a traumatic
event that he/she is unable to ‘reach’ beyond. Again, this is a matter requir-
ing skilled support. Having said this, repetition is not always intended to be
a communication to the therapist since it can occur when children want to
work through something for themselves while using an activity medium.
Repeated play can indicate a child’s need to rehearse something they want
to implement, such as a tricky communication with a parent, but which does
not directly ‘involve’ the therapist. There are occasions when a child revisits
an earlier activity but in a manner that indicates a change has taken place in
their own process – perhaps he/she has found an ‘answer’ to their difficulty.

Exercise

Consider how you might deal with an error or omission during a play therapy
session. After this session you realise that you possibly misinterpreted a point made
by your client that may have caused him/her to become quiet and appear somewhat
withdrawn. Describe the process you would follow to understand what happened
and how. Giving your reasons, how would you propose to deal with this?

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Boundaries in Child-centred Therapy  163

The constraints of time-limited therapy


Adhering to a predetermined maximum number of sessions available to a
young client, whether in play therapy or in working with older children, will
be anathema to the child-centred practitioner. Time-limited or solution-
focused systems are generally not child-centred and yet pressures continue
to be applied to therapists who work with children. It is not my purpose to
try to validate this view, for Axline (1947: 126) described the child-centred
viewpoint most eloquently when she said:

If the therapist is seeking to relieve tensions and pressures and to give the child a
feeling of adequacy, she will not follow the ‘hurry pattern’. She will recognise the
value of giving the child an opportunity to gain his equilibrium. She will let the
child take his time.

She emphasises her view by declaring, ‘If he wants to sit there and look,
then he sits there and looks – for the entire hour if he desires to do so’.
Axline sums this up with, ‘Finally, the child begins to notice that the usual
pressure to hurry him along is absent. There is visible relaxation’ (Axline,
1947: 126).
Landreth and Sweeney (1997, 2001) are compelling when they remark that
the establishment of treatment goals is incongruent with the philosophy of
child-centred theory. They go on to state with remarkable succinctness:

The central hypothesis governing what the therapist does is an unwavering belief
in the child’s capacity for growth and self direction. The establishment of specific
treatment goals would be a contradiction of this belief. Goals or objectives of
treatment implied that the therapist knows where the child should be and that
there is a specific structure by which to get there. The therapist is not wise
enough to know where another person should be in his or her life, or what that
person should be working on or toward. Life is much too complex to be under-
stood by diagnosis and controlled by a prescription for growth. Further, the child
is the best determiner of what should be focused on in play therapy. How can
children learn self-direction if even their play is directed? Diagnostically based
treatment goals usually results in the therapist’s being focused on the treatment
goal. Such an approach would be much too structuring and would restrict the
creative potential of the child and the relationship. (In Landreth and Sweeney,
2001: 188)

I know only too well that in private practice it is possible to be ‘true’ to the
child-centred philosophy when working with children and young people. In
certain types of managed services, where there are restrictions on financial
and therapeutic resources, practitioners will need to be mindful of the
requirement to adhere to the stipulated constraints. This can present a philo-
sophical conflict of interest that some practitioners may find hard to accept.
Nevertheless, practitioners whose primary source of income is derived from
their therapeutic work need to seek an accommodation with themselves and
also their managing organisation. Finding a compromise that is comfortable
for the child-centred practitioner might necessitate a careful assessment of

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164  Person-centred Therapy with Children and Young People

the proposed organisation they might be thinking about joining. An organi-


sation that offers flexibility within its policies is likely to be more attractive
from a child-centred viewpoint than one that is doctrinaire and prescriptive
towards its practitioners.
Children and young people do not continue within a child-centred thera-
peutic relationship when they believe they have gained from the process
what they require. This arises when clients feel they have control of the
relationship and are able to make a decision about remaining in therapy.
Therapists whose style of relationship generates inappropriate transference
to children may therefore find a child comes to therapy because he/she feels
it is their task to try to accommodate the practitioner’s personal needs.
Within a family, it is not at all unusual for children to meet the unstated
expectations of, for instance, an adult family member. Care must be taken to
ensure that, in a therapeutic relationship, children are free to be themselves.
When considering broad limits in relation to the total number of therapy
sessions provided to children and young people, age alone can reveal a dif-
ference of need. As a general guide in my ‘mixed’ practice, the average
number of sessions per child client is about 14 sessions. Working with young
people, the figure is about 8 sessions, but these figures represent a broad-
based client group. For instance, if therapy is provided to a specific client
group, such as young people with significant anxiety, then the average ses-
sional uptake is likely to be markedly greater.
Through experience, practitioners will find the confidence to build their
knowledge and skills; this may then be converted to tangibly successful
representations. On the subject of short-term therapy with young children,
Johnson (2001: 217) comments:

Professionals are often required to defend their practice to managed care


organisations that are concerned with cost-effective, goal-oriented, time-limited
therapy (Cummings, 1995). Therapists must actively educate themselves about
current research on outcomes and short-term therapy for two reasons: (a) to
provide managed care organisations and other professionals research-based
evidence of the effectiveness of child-centred therapy as a treatment modality
for children, and (b) to combat the common belief that effective therapy
requires a lengthy commitment.

Johnson goes on to say that short-term therapy (which she defines as up to


12 sessions), ‘is not recommended for all children and all difficulties. The
number of therapy sessions needed will depend on a multitude of factors,
including the child’s age, emotional maturity, family stability, severity of
trauma, duration of the trauma as in the case of sexual abuse, and parent’s
response to the child’s difficulty’ (2001: 233).
In child-centred therapy, it is not unusual for children to appear to act out
in such a way adults might believe therapy is making a child ‘worse’. This is
quite normal and, given the space and time, children will find the means
towards self-understanding. Adults seeking tangible improvements in a

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Boundaries in Child-centred Therapy  165

child’s behaviour, for instance, may quickly become disappointed and disaf-
fected by therapy. As practitioners it is essential to be aware that, at the
conclusion of therapy, we may not be able to identify with accuracy the
changes that therapy may have facilitated. The benefits may slowly become
apparent only over a prolonged period. My experience indicates that it can
take more than one year following the completion of therapy for this transi-
tion and even then only if the child concerned experiences the constancy of
family and boundaries. If a child gains a positive experience of therapy, then,
if further support is needed in the future, he/she will be reminded of that
earlier experience. The child – as a teenager or an adult – will be more
knowledgeable about the possibilities of therapy and will seek a therapist
who will equal or even exceed that previous benchmark. Moreover, that
individual will be confident in asking for support and he/she might in turn
be in a position to positively affirm the benefits of therapy to friends and
relations.

Exercise

You are a child-centred therapist and are looking for additional hours. Having
responded to an advertisement, you are invited to attend an interview in a
managed service that operates a policy of short-term therapy. In preparation for
this interview, consider what information you require from the interviewer in
relation to the organisation’s operational policies. With what conditions would
you be comfortable and what might compromise your child-centred training?

Ending a session
Ending a session with a teenage client is generally straightforward: at the appro-
priate time (usually after 50 minutes) the practitioner will inform the client that
the session needs to end. With a teenage client I will conclude the session with
a form of words I would offer an adult, such as ‘I am afraid we have run out of
time and we need to leave it at that for now’. I tend to link this statement with
relevant ‘connecting’ words from the client’s last remarks so that the ending – at
least to my satisfaction – feels less abrupt and intrusive. Bringing a session to a
close with children can be more complicated. Whether working with children or
young people, the practitioner is responsible for ensuring the session finishes on
time, although the process for implementing this will, to some extent, depend
upon the individual client.
Children can be remarkably inventive when they are having a good time
and do not want the session to finish. I have had my clock hidden in the
hope that I will lose track of time; or a child volunteers to tidy up having first
made a mess using the most awkward things to put away (such as magnetic

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166  Person-centred Therapy with Children and Young People

construction kits). Children whose parents collect them gain another oppor-
tunity to prolong a session. While some children will ask me to put away
their activity before their parent arrives, others want to show what they have
been doing. Some children want to be able to make a connection with their
parent in this way, perhaps to reinforce a link with the practitioner. I appreci-
ate that I am less strict about the time boundary than many practitioners, but
I can offer a couple of examples when I felt that a less formal ending of the
session seemed facilitative to my clients.

The first concerned Lizzie (aged 8) who, towards the end of a session, said she
would like her father to see the complex character scene she had devised. Lizzie
had taken great care to assemble this scene as if she had done so for her father’s
benefit. When he came into the room and sat down, Lizzie described the scene to
him and having received a positive reaction, then vigorously demolished her
‘creation’. Given her actions immediately prior to her father coming in, Lizzie
appeared frustrated with him and the act of demolition was her way of communi-
cating her feelings. I told Lizzie’s father that I felt she was trying to tell him some-
thing and that perhaps, away from this session, he might talk to her about it.

My second example concerned Sean (aged 6), who had witnessed arguments and
violence between his parents. Some months following the parental separation – his
father having left the family home – Sean’s mother arranged therapy. At the end of each
session Sean’s mother would come to collect him and it seemed to me that while we
talked for a few minutes about nothing in particular (certainly not about his therapy),
I sensed it was important for Sean that he could experience what it was like for his
mother to have a ‘normal’ conversation with another adult. I felt these unplanned few
minutes after each session made an important contribution to Sean’s process.

Exercise

It is the responsibility of the practitioner to end an individual therapy session.


Reflecting on your personality, consider what kind of situations might challenge
you and how you would deal with them in two ways: first, how you might address
these outside the therapeutic environment and, secondly, within the therapeutic
relationship.

Summary
This chapter describes the provision of boundaries in play therapy, exploring
practical issues relating to establishing and maintaining boundaries. As well

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Boundaries in Child-centred Therapy  167

as providing a foundation for therapy, these boundaries define acceptable


limits while nurturing and facilitating clients. Practitioners have a central
role, but clients also have a responsibility to the therapeutic relationship. In
play therapy, the complexity is such that therapists need to be alert to a vari-
ety of layers that may be encountered in a typical session. Practitioners will
be alert to ways in which clients may test the relationship.
The philosophy of child-centred therapy can at times be questioned, nota-
bly when working within a managed service. This can give rise to conflict
and uncertainty for practitioners who need to find acceptance for require-
ments that may run counter to child-centred provisions.
Finally the ending of sessions and therapy is explored and some of the
issues that practitioners need to manage is described.

Suggested further reading

Baggerly, J., Ray, D. and Bratton, S. (eds) (2010). Child-Centered Play Therapy Research:
The Evidence Base for Effective Practice. Hoboken, NJ: John Wiley & Sons.
Berry, J. (1971). Helping children directly. British Journal of Social Work, 1(3): 315–32.
Cattanach, A. (1992). Play Therapy with Abused Children. London and Philadelphia,
PA: Jessica Kingsley Publishers.
Jennings, S. (1999). Introduction to Developmental Playtherapy. London: Jessica
Kingsley Publishers.
Landreth, G. and Sweeney, D. S. (1997). Child-centered play therapy. In K. O’Connor
and L. Braverman (eds), Play therapy: Theory and Practice (pp. 17–45). New York:
John Wiley & Sons.

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12
Multi-professional Practice

Covered in this chapter:

•• Introduction
•• Policy frameworks
{{ Introduction
� Background
� Every Child Matters

{{ Child-centred services

{{ Sharing expertise

{{ Mental health

•• Child-centred therapists in multidisciplinary practice


{{ General approach
{{ School settings

Introduction
I sense that therapists often feel they operate in a professional vacuum
where connections with other professional groups are at best informal and,
at worst, non-existent. Counselling therapy in the United Kingdom, for
example, has become somewhat characterised by the development of profes-
sional bodies with their own codes of practice and registration requirements.
While individual counselling bodies have something unique to offer, it is
hoped that organisations such as those offering membership to practitioners
working with children and young people can develop a programme to share
knowledge (between organisations) that benefits both the profession and
clients.

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Multi-professional Practice  169

Therapeutic modalities can appear to compete rather than collaborate,


thus generating exclusivity over inclusiveness and valuing specialism over
wholeness. The development of meaningful multidisciplinary practice (with
professionals such as social workers, educationists, health visitors, speech
and language therapists) can, through shared experience, further enhance
the support given to individual children, young people and their families/
carers. Sommerbeck, in The Client-Centred Therapist in Psychiatric Contexts
(2003), describes her experience of the ‘duality’ of being a client-centred
therapist in a medical model setting. While being true to her client-centred
credentials, she is also able to find the means within her to professionally
relate effectively with the patterns and processes that the medical model
embraces. I believe this is true also of child-centred practitioners.
It is incumbent upon child-centred practitioners to openly accept the operat-
ing frameworks of professionals in other groups, even if there may appear to
be philosophical differences. For example, child-centred practitioners inher-
ently acknowledge that a child can be his/her own ‘expert’, but within the
medical model, therapists (of any related professions) are often considered the
‘expert’. Sommerbeck (2003: 5) remarks on the importance of working with
respect for other modalities ‘without compromising the philosophy inherent
in his own work’. This is essential if child-centred practitioners are not to
alienate and isolate themselves. Inner certainty will enable child-centred
therapists to be open to the ways of working of others while maintaining a
professional grounding in their values and beliefs.
The next section in this chapter outlines the opportunities that are available to
therapists working in a multidisciplinary team to illustrate aspects of practice
within a school setting. Being part of a team contributes a further dimension to
the therapist’s experience and skills that can be both rewarding and challenging.

Policy frameworks
Introduction
Researching this chapter in relation to the UK, I reviewed a number of policy
documents on multi-agency approaches to working with children and young
people, such as England’s Every Child Matters (DfES, 2003, 2004a, 2004b).
Many nationally-produced publications and papers appear to reinforce a ‘top
down’ approach, with limited reference to the possibilities that therapeutic
support can play in advancing the well-being of children and young people
in a multidisciplinary environment. The effective integration of counselling
therapy for children and young people within the community of services
established to serve their needs is therefore likely to be achieved on a local
level. Moustakas (1959: 44) says of the smooth flow of therapeutic work,
aided by agreement between the therapist, carers and other professionals:
‘When cooperation and mutuality exist among these significant persons, it is
rare that the child does not begin to move in a positive direction.’

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170  Person-centred Therapy with Children and Young People

Background
Choosing to include a section on English policy frameworks (and recognising
other countries have their own structures), I decided to review key publica-
tions by the government’s Department for Children, Schools and Families
(DCSF) (formerly Department for Education and Skills) and to draw from
these a short policy summary. Since 1998, the DCSF has produced hundreds
of publications, so I have chosen to focus on a substantial piece of policy,
Every Child Matters (ECM), and its successor documents. I found helpful
guidance in Making Sense of Every Child Matters, edited by Barker (2009), but
the complexity of ECM has felt overwhelming. Multiple layers of policy
seemed to generate systems of complexity and magnitude. Simon and Ward
(2010: xi) refer to the breadth and scope of ECM as ‘bewildering’ and involv-
ing ‘almost every government department and every frontline professional
across the public, private and voluntary sectors’. I have renewed respect for
practitioners struggling to deliver services within this framework.
In her final report of a child protection review in which she proposes a
child-centred system, Munro (2011: 20, paragraph 1.21) says:

From the perspective of the front line, this [review] has contributed to many feel-
ing that they are working in a compliance culture where meeting performance
management demands becomes the dominant focus rather than meeting the
needs of children and their families. When these conflict, even the most dedi-
cated child-centred professionals can feel pressured to prioritise the performance
demand over the child’s needs.

A further statement by Munro is unremittingly direct when she says:

The system should be child-centred: everyone involved in child protection should


pursue child-centred working and recognise children and young people as indi-
viduals with rights, including their right to participation in decisions about them
in line with their age and maturity. (2011: 23)

Another statement by Munro that Rogers himself might have made is:
‘Helping children is a human process. When the bureaucratic aspects of
work become too dominant, the heart of the work is lost’ (2011: 10).

Every Child Matters


In 2003, the English government published a consultation document Every
Child Matters, followed by Every Child Matters: Next Steps (DfES, 2004a) and
passed The Children Act 2004, thus ‘providing the legislative spine for devel-
oping more effective and accessible services focused around the needs of
children, young people and families’ (DfES, 2004a: 13). Subsequently, a fur-
ther document, Every Child Matters: Change for Children (DfES, 2004b), sought
to improve the well-being of children and young people from birth to age 19.
It stated that success would in large measure depend upon the degree to

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Multi-professional Practice  171

which organisations and individuals were enabled to work collaboratively


for the benefit of children and their families. Information sharing was
regarded as a crucial component of the ECM reform, requiring collaboration,
and the DCSF (2010) emphasised that effective information sharing between
different agencies underpinned integrated working.
Collaboration implies ‘conscious interaction between the parties to
achieve a common goal’ (Meads and Ashcroft, 2005: 16). Huxham (1996)
applies the term ‘collaborative advantage’ to a situation in which an out-
come is only achievable through collaboration and where participants, indi-
viduals or organisations also benefit in some way from the collaboration.
Similarities are acknowledged and differences are valued within a secure founda-
tion of commitment by professionals to collaborate and within which prac-
tice is characterised by action and partnership (Quinney, 2006).
Graham and Machin (2009) identify concerns in respect of the unique
nature of individual professions. They suggest that inter-professional work-
ing can have a negative impact on professional identity, leading to a lack of
willingness to engage in collaborative, inter-professional working and cause
professionals to display defensive behaviour towards one another. Accord-
ing to Graham and Machin (2009: 40):

For the past two decades, services for children and families have been subject to
unprecedented change. Maybe it is time to slow down and allow these new ways
of working to embed, develop and produce the desired results of a collaborative
culture which has the welfare of children at its heart.

A prominent theme in ECM – improving outcomes for children, young peo-


ple and their families – can only be achieved by transforming the ways in
which professionals organise and are managed. Hoyle (2008) prepared a
critique of ECM in which he comments:

Central to the Every Child Matters way of thinking is a re-enforcement and per-
petuation of a focus on visible ‘symptoms’ in the lives of children, young people
and families. A shallow focus obviates any critical dialogue about the structural
inequalities in contemporary England from which such ‘symptoms’ can emerge.

On the continual process of assessing and making decisions about the develop-
ment, behaviour and circumstances of children, young people and their fami-
lies, Hoyle remarks that the norms inherent in ECM are ‘socially constructed’.

Child-centred services
French (2007) considers the child-centred and family-centred approach to be a
‘significant shift towards multi-agency provision and should identify if ser-
vices are meeting children’s needs.’ If the service is not operating on this basic
premise, questions need to address what can be improved or enhanced’
(French, 2007: 59). She then qualifies this, since it ‘sounds naive as resources

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172  Person-centred Therapy with Children and Young People

cannot provide for every need; however, the resource argument is often an
excuse for not tackling change in the first place’. French also comments that
child-centred approaches rely on practitioners spending time talking to chil-
dren and families about what is ultimately important for them. Bronfenbrenner
(1979) said that to construct a social model that is acceptable across agencies,
child-centred provision in terms of service planning needed a holistic approach.

Sharing expertise
Sharing expertise will help inform and develop professional practice and ben-
efit children and young people. Stanley (2007: 124) says: ‘Different agencies,
such as speech and language therapists, psychologists, health visitors, nurses,
play workers and academics, have an important role to play in advising and
supporting each other on meeting children’s individual needs. They can learn
from one another.’ On multidisciplinary working, French (2007: 124) remarks,
‘Each complements the other’s knowledge and area of expertise. If the logic of
this argument is so clear, why then is multiagency working viewed as such a
challenge that it requires national interventions to promote it?’ In 2005, the
Department for Educations and Skills (DfES) published the Children’s Work-
force Strategy and, in its vision for the children’s workforce, stated:

We are looking to overcome the restrictive impact that professional and organi-
sational boundaries can have so that increasingly professionals and practitioners
from different sectors work better together in multidisciplinary teams around the
needs of children and young people and share an increasingly common language
and understanding. (DfES, 2005: 3, paragraph 2)

The government’s concept of the ‘Team Around the Child’ (TAC), in the glos-
sary to ECM, is a model of service provision in which a range of practitioners
from diverse fields come together to support an individual child. The needs-led
approach, according to Cheminais (2009: 71), ‘suggests a group of professionals
working together only when required to help in improving outcomes for a
particular child or young person … working with a range of different col-
leagues at different times to support particular children’. The TAC brings
together professionals and practitioners who may not normally work directly
with each other, but who all work with children and young people. As Chemi-
nais (2009: 71) states, ‘The TAC requires professionals to work in a different way
and to offer a range of successful support mechanisms. The team works
together to plan a coordinated support from agencies to address problems in a
holistic way.‘ The similarity with Bronfenbrenner’s (1979) statement is striking.

Mental health
Layard and Dunn (2009: 113) state: ‘Most of our children lead happy lives, but
a minority are seriously troubled or disturbed. Mental health difficulties of
this kind are one of the greatest barriers to wellbeing and a good childhood.’

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Multi-professional Practice  173

Yet, according to Green et al. (2005), only a quarter of the children affected get
any kind of specialist help. This estimate excludes educational psychologists,
who mainly provide assessment. Layard and Dunn (2009: 113) comment:

[T]his neglect is extremely unjust when these children need so much support. It
is also short-sighted, since children who display these difficulties in childhood, if
not helped, will be highly likely to become troubled and disturbed adults. Many
will continue to be mentally ill, and much more likely than other children to
become drug or alcohol addicts, teenage parents or criminals.

Healthy Lives, Brighter Futures – The Strategy for Children and Young People’s
Health, specifically Standard 9 – The Mental Health and Psychological Well-
being of Children and Young People, (DCSF, 2009: 102), states:

All children and young people, from birth to their eighteenth birthday, who have
mental health problems and disorders (should) have access to timely, integrated,
high quality, multi-disciplinary mental health services to ensure effective assess-
ment, treatment and support, for them and their families.

In the context of Every Child Matters (DfES, 2003), the primary agents in
developing multidisciplinary mental health services for children and young
people are the local child and adolescent mental health services (CAMHS).
Brownrigg (2009) describes CAMHS as a broad term that ‘captures all people
who come into contact with children, including health, education and social
care professionals’. Services are geared towards children and their needs are
viewed in the context of the family system. In general, CAMHS identify,
assess and promote mental health for children and young people from birth
to 16–18 years of age. These organisations operate through multi-agency col-
laboration. The Office for National Statistics (ONS, 2005) indicate that one in
ten children aged between 5 and 16 will have a recognisable mental disorder.
This assessment equates to over 1 million children and young people in that
age group within the UK. This figure is broadly comparable to the level of
incidence in the USA (US Surgeon General). Brownrigg (2009: 169) says,
‘Statistics, however, do not capture every child and their family, so it is pos-
sible that the number of children experiencing mental ill health could be
considerably under-reported’. CAMHS operate within a boundary endorsed
by age criteria, usually 0–16, but when children reach their 16th birthdays it
can be difficult to determine which service will respond to their needs. Adult
services commence at 18 years old and experience indicates that in the inter-
vening two years, continuity of service can be patchy. In a study of young
people aged between 16 and 25, Smith and Leon (2001) established that
many young people were disappointed with the provision they received and
found they did not easily fit into child- or adult-focused services.
Professionals who practise in CAMHS may include cognitive behavioural
therapists, creative therapists, such as art and drama therapists, and those men-
tioned by Brownrigg (2009: 171) ‘whose roots are within the psychoanalytical

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174  Person-centred Therapy with Children and Young People

and psychodynamic tradition. These methodological and therapeutically differ-


ent approaches, when available in CAMHS settings, have the potential to pro-
vide choice for clients.’ Services tend to fit readily into a template geared to a
medical model of care. Wolpert et al. (2006: 5) say ‘Practitioners’ choice of
approach is always a decision-making process guided by a range of factors
including the characteristics of the referred child/young person, their family
and social circumstances as well as the service context.’

Exercise

Meeting the emotional and mental health needs of children and young people
within a multidisciplinary framework is sometimes described as ‘child-centred’.
Thinking about your own organisation or one that may be familiar to you, how
child-centred are the services? Compare this with your understanding of the
child-centred therapeutic relationship.

Child-centred therapists in multidisciplinary practice


General approach
Child-centred practitioners may find opportunities to liaise on a multidisci-
plinary basis since working with a child is often likely to include other pro-
fessionals, even if only to be aware of their current involvement in the child’s
life. Many young children present different behaviours and emotions at
school from those they express and communicate at home. A teacher may
observe a characteristic in an individual child and, without knowing what the
action represents, recognises that something could be amiss. Sensing such a
situation, the teacher might, after consultation with colleagues, choose to
have a word with the child’s parents. I have received referrals from parents
that have been initiated by a concerned teacher about a child’s well-being.
From the outset, the child-centred therapist has the means to establish a
relationship with a professional in another discipline.
How practitioners manage multidisciplinary relationships is a reflection
of their ethos, training and confidence. Some practitioners may believe it is
inappropriate to share any information about a child client with anybody;
others may comfortably communicate with professionals from other disci-
plines. I find that a child’s needs are often assisted by my having contact
with other appropriate professionals.

Annie (aged 14) has cystic fibrosis and regularly meets her specialist nurse. In her
sessions my client will often refer to the nurse by name and we have met at school
review meetings along with Annie’s parents. I will talk to Annie about forthcoming

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Multi-professional Practice  175

reviews and identify any points she would like me to represent on her behalf. Annie
generally chooses not to attend because of missing lessons, and providing feedback
lets her know that as professionals, albeit in different fields, we are heading in a
mutually agreed direction. When considering people who are significant in a
child’s life, it is important to appreciate that such people may be other professionals
such as teachers or, as in Annie’s case, her specialist nurse. It is reasonable for
children to expect significant adults to work with each other for their benefit.

Child-centred practitioners have respect for their clients and if this objec-
tive can be appropriately served through coordination with other related
professionals, then engaging in a multidisciplinary process will be worth-
while. Nevertheless, practitioners need to ensure that the confidential
requirements of the client relationship are maintained.
Whatever the professional discipline, boundaries of responsibility or
interest will almost always overlap with another discipline. The child
who has a mild speech impediment might be referred to a speech and
language therapist for specialist help. It is also possible that an experi-
enced child-centred therapist may have a legitimate role if, for instance,
assessment indicates the impediment may be due to anxiety.

Jeff (aged 17) had left school after his GCSEs, which were adversely affected by
his lowered sense of self-worth. He had a stutter and tic that led to him being
taunted by his Year 11 peers. These became more pronounced as his anxieties
increased. Jeff explained that his parents had separated and he felt pressured by
both to support one against the other. His anxiety would build up when he
returned home to his mother following a stay with his father. Therapy enabled Jeff
to establish emotional independence, and as he did so the stutter and tic slowly
disappeared. He was able to accept a place at college the following academic
year to resume his academic studies.

Occasionally, professionals from another field may request support in rela-


tion to a child with whom they are working as a consequence of a referral hav-
ing been made for specialist assessment. It may become apparent that their
client’s physical condition – for which referral was made – also has associated
emotional needs. These support opportunities have been enlightening both for
my professional ‘clients’ and myself. Not only are we able to share experience
and learn from each other, but I genuinely believe these encounters do much to
facilitate the spread of knowledge and experience of child-centred practice.
Working with professionals from other disciplines has in my experience been
both positive and worthwhile. The quality of support for children can be fur-
ther enhanced by mutuality among professionals and openness to each other’s
ideas and experiences. However much individual professionals want to
engage with each other, organisational constraints can seem to militate against

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176  Person-centred Therapy with Children and Young People

effective multidisciplinary functioning. A shared approach works where there


is trust and an open recognition of the need for professionals to come together
in the interests of the children they are supporting. A bottom-up approach can
valuably enhance more flexible organisational and professional attitudes.

Exercise

Reflecting on child-centred practice, to what extent would you consider it


appropriate to participate in multidisciplinary practice? Describe your views and
explain what provisions would be needed to safeguard the confidentiality and
integrity of the therapeutic relationship.

School settings
Looking at the provision of therapy in schools, I reviewed three background
documents that seemed to offer some insight into future developments
involving multidisciplinary practice. These were:

•• Promoting Children’s Social and Emotional Wellbeing in Primary Education,


published by the National Institute for Clinical Excellence (NICE, 2008). This
guidance for teachers, school governors, and staff in local authority children’s
services, primary care and child and adolescent mental health services, described
‘a range of interventions that have been proven to be effective, according to the
child’s needs. These should be part of a multi-agency approach to support the child
and their family and may be offered in schools and other settings’ (NICE, 2008: 10)
•• Targeted Mental Health and Emotional Wellbeing Services in Schools (TaMHS)
(DCSF, 2008b), a national research project established in 2008, supported by the
then Department for Children, Schools and Families and the National CAMHS
Support Service. This project developed from Every Child Matters: Change for
Children (DfES, 2004b) and recognised the need for health provision improvements
in services for children and young people. TaMHS – a three-year pathfinder
programme ending in 2011 – was described as a major innovation in research in
education and mental health in the UK. Primarily the TaMHS project aimed ‘to bring
more practitioners with mental health expertise into schools to help school staff
develop their skills and confidence in identifying and supporting children with
mental health needs’ (DCSF, 2008b: 3). A school carrying out the kind of whole-
school approach envisaged by TaMHS would be putting the NICE approach into
practice and extending it by offering individual, more intensive support to children
and families where appropriate. The findings of the national TaMHS project
published in November 2011 by the DfE included prioritising work in primary
schools to have ‘maximum impact before problems become too entrenched’, and
in secondary schools, to ‘prioritise improved inter-agency working … to help
address behavioural problems’. (DfE 2011c: 13)
•• School-Based Counselling Operating Toolkit, jointly published by the British
Association for Counselling and Psychotherapy (BACP) and the Welsh Assembly
Government in 2008 following a six-months research study into counselling in

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Multi-professional Practice  177

schools commissioned by the Welsh Assembly Government. The study made ten
recommendations to ‘inform the structure and content of the Toolkit’, including the
employment of ‘professionally qualified counsellors who have experience of
working with young people, who access appropriate clinical supervision with
experienced supervisors, and who take part in regular, relevant continuing
professional development’ (BACP and the Welsh Assembly Government, 2008:
125). It also describes practitioners working ‘with and alongside other services and
agencies in a collegial manner, whilst maintaining appropriate levels of
confidentiality’ (2008: 126).

Of all the organisations in which counselling therapy is provided for chil-


dren and young people, schools are the most likely since all children are
required to receive education at least to the age of 16. Many schools have no
counselling provision. Cromarty and Richards (2009: 5) state:

In England there is no national strategy for counselling in schools, and although


counselling as a professional activity is prevalent in more than 50 per cent of
English schools, this is as a result of local agreements. In Wales, the Welsh Assem-
bly Government has developed a National School-Based Counselling Strategy
[described above]. In Northern Ireland, all post-primary schools have had the
opportunity for school-based counselling since 2007, following the implementa-
tion of a Northern Ireland National School Counselling Strategy (Independent
Counselling Service for Schools) programme. Finally, in Scotland, there is an
aspirational target from the Scottish government to have accessible counselling
for all school children by 2015.

Baginsky (2004: 3) talks about the ‘growth of interest in counselling in soci-


ety generally, the effects of educational legislation on schools’ priorities and
responsibilities, and what are often seen to be the challenges and stresses of
contemporary life on young people’. Hornby (2003: 13) mentions that coun-
selling in schools ‘is not a specific, isolated, helping strategy which is on
offer but is part of a continuum of helping strategies, ranging from directing,
and advising through to supporting and counselling’. Lane (1996) comments
that teachers currently tend to use more helping strategies at the directing
end of the continuum rather than at the counselling end. Harris (2009: 174)
spoke of there being ‘some evidence of skepticism at managerial levels,
about the potential “fit” between counselling and the educational priorities
of schools’. She concludes, ‘more needs to be done locally and nationally to
enable them [counsellors] to take their rightful place as professionals in a
truly integrated and inclusive service in which every child, every teacher,
and every professional matters’ (pp. 179–80).
Cooper (2009) described a study of the nature and outcome of counselling
in secondary schools in the UK (serving the 11–18 age group). From
responses received about the source of referral, some 60 per cent of those
schools studied indicated that, on average, ‘clients were almost three times
more likely to be referred by pastoral care teachers than by any other source’.
Incidentally, this same study concluded that, typically, ‘counselling services

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178  Person-centred Therapy with Children and Young People

provided purely person-centred or person-centred based, forms of therapy’


(Cooper, 2009: 139).
Hornby (2003) comments that various authors estimate that between 10
per cent and 20 per cent of school-age children exhibit emotional and
behavioural problems. Mosley (1993: 105) argues for counselling in all
schools ‘as a vital positive force in pupils’ lives, a means of helping young
people “think for themselves, make their own decisions, value their own
integrity”’. Hornby refers to the ‘importance of teachers being able to use
basic counselling skills in order to help a substantial number of their stu-
dents’. It is perhaps the case that all teaching staff should be equipped
with an appropriate level of listening skills and that experienced practi-
tioners may appropriately provide skills training within the school.
Hornby (2003: 2) also says that:

When schools are mainly concerned with ‘delivering’ an academic curriculum,


other aspects of the school’s role, such as providing personal and social educa-
tion, tend to be overlooked. This leads to insufficient attention being paid to the
needs of children for counselling and guidance and therefore also to a lack of
appreciation of a key role which teachers can play in meeting these needs.

Bor et al. (2002: 1) says: ‘The requirements of the Children Act 1989 for pas-
toral provision in schools has encouraged some schools to set up a formal-
ised counselling service’. They also describe the distinction to be made
between professional work with a child or young person (client) and others
involved in the everyday life of the client (family and school). For Bor et al.,
‘a minimum of three systems is involved in dealing with a school problem
at any one time – the child [or young person], family and school. The par-
ticipation of a counsellor and the inclusion of the problem as a part of the
interactional system results in a more comprehensive depiction of transac-
tions between the child, the family, the school, the problem and the counsel-
lor’ (2002: 25). This can generate challenges for the child-centred practitioner
who may try to remain neutral and Bor et al. underline this remark thus: ‘In
these settings, counsellors may be confronted with complex interactions
between different members of the system which [can] develop into an
intense emotional climate’ (2002: 25).

Exercise

Children and young people can benefit from counselling therapy, with teaching staff
being central to a school’s pastoral provision. You have been invited to make a
submission to the governors of your local school, outlining the case for introducing
a professional counselling service. Providing a comprehensive argument, what
elements would you consider including in your submission and why?

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Multi-professional Practice  179

Summary
This chapter describes the provision of multidisciplinary services to meet the
emotional needs of children and young people. A policy framework states
that professionals continue to develop local services that are inherently
child-centred. This framework represents a top-down approach and imposes
significant demands upon the professionals who are responsible for service
delivery.
The relationship of the child-centred therapist to multidisciplinary teams
is one that is dependent upon the experience and training of individual prac-
titioners. When applied sensitively and with full regard for the needs of
specific clients as well as their requirements to maintain the required degree
of confidentiality, multidisciplinary arrangements can be both facilitative
and provide positive benefits for children and young people.

Suggested further reading

Barker, R. (ed.) (2009). Making Sense of Every Child Matters: Multi-Professional


Guidance. Bristol: The Policy Press.
Cheminais, R. (2009). Effective Multi-Agency Partnerships: Putting Every Child Matters
into Practice. London: Sage.
French, J. (2007). Multi-agency working: the historical background. In I. Siraj-Blatchford,
K. Clarke and M. Needham (eds), The Team Around the Child. Stoke-on-Trent:
Trentham Books.
Layard, R. and Dunn, J. (2009). A Good Childhood: Searching for Values in a
Competitive Age. Harmondsworth: Penguin.
Simon, C. A. and Ward, S. (2010). Does Every Child Matter? London: Routledge.

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13
Aspects of the Law in Child-centred
Therapy

Covered in this chapter:

•• Overview
•• Parental responsibility
{{ Age boundaries
{{ Parental responsibility (for children)
{{ Acquisition of parental responsibility by the father

{{ Parental responsibility and medical consent

{{ Joint registration of the birth by the father and mother

{{ Family proceedings

{{ Child and Family Court Advisory Support Service (CAFCASS)

{{ Children affected by divorce or separation

•• Legal proceedings and therapy

Overview
Starting in independent clinical practice, my knowledge of related legal matters
was limited, and once I began to see children and young people particularly, this
was something I needed to address. I believe it is important that practitioners
understand the law affecting aspects of child-centred therapy. I have developed
my professional practice to embrace aspects of therapy in which the application
of the law can profoundly influence the emotional well-being of children and
young people. My practice has evolved in this direction as I have continued to
accumulate experience: it may, naturally, represent a field of work that other
practitioners may choose not to enter.

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Aspects of the Law in Child-centred Therapy  181

A significant body of legislation directs the treatment and care of adults,


especially those with restricted autonomy, but, generally speaking, such
legislation has its primary influence in relation to the work of specialist prac-
titioners such as those responsible for implementing mental health legisla-
tion. Within independent practice, the law related to providing therapy to
children below the age of consent is itself open to specific interpretation and
some aspects can represent a substantial ‘grey’ area for practitioners. This
chapter describes the broad legislative framework, offering some case exam-
ples, and encourages child-centred practitioners to gain some knowledge of
the relevant law.
It is in my nature to be alert to legal ‘curiosities’ that arise in client experi-
ence. Child-centred practitioners working with families will have their own
experiences, about which I hope the profession can, in time, become more
vocal. There are occasions when, in civil law particularly, people feel let
down by decisions that appear to run counter to the needs of individual
children and families. Mitchels (2009: iv) says: ‘Lawyers and practitioners
from other disciplines working with children should meet together as often
as they can to share their ideas and experience, debate thorny issues, tackle
challenges and celebrate success.’
When a client shares information, it is his/her truth and it might not be
acknowledged by other significant participants in what can become or is
already part of a legal process. A further argument sees relevant experience
being ‘kicked into the long grass’ and labelled as ‘anecdotal’, even though
‘worked’ examples can inform legislative re-framing. In time I hope practi-
tioners in all professions involved in the well-being of children and young
people may have the means to submit appropriate cases to a national body
for formal review. Practitioner experience can provide an authoritative pool
of reference to help enhance and inform legal practice.

Parental responsibility
Much of the current legislative framework concerning children and young
people is embodied in the Children Act 1989. Mitchels (2009) provides a
comprehensive glossary and framework, although, as with any legal publi-
cation, there have been changes since this was published, such as the intro-
duction of the Supreme Court replacing the UK’s House of Lords.
The Children Act 1989 created a three-tiered unified court system: the
High Court, the County Court and the Family Proceedings Court, each of
which have concurrent jurisdiction and powers. As Mitchels points out,
‘Cases may move up or down the tiers, transfers therefore being easier’
(2009: 9). The Act created a new system of directions hearings to enable
courts to take firmer control of the timing of cases, admission of evidence
and administrative matters. When the court determines any question with
respect to the upbringing of a child or the administration of a child’s prop-
erty, the child’s welfare shall be the court’s paramount consideration. In

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182  Person-centred Therapy with Children and Young People

proceedings in which questions with respect to the upbringing of a child


arise, the court shall have regard to the general principle that any delay in
determining the question is likely to prejudice the welfare of the child.
The legislation affecting children and young people is complex and I can
do no more than touch upon those aspects of the law that practitioners might
encounter in their work. From time to time I find it necessary to refer to a
past significant experience, or to seek advice from perhaps my professional
supervisor, manager or a solicitor, who is usually accessible through profes-
sional indemnity provisions maintained by the practitioner. Suggested fur-
ther reading at the end of this chapter will offer guidance to those wanting
to know more. I have selected aspects of legislation that are relevant to a
therapist’s preliminary understanding of the law. Put simply, these are provi-
sions with which I have become acquainted either through direct profes-
sional association or by client experience.
The website www.legislation.gov.uk details the Children Act 1989 and
incorporates changes made by subsequent legislation. While outstanding
legislative changes are yet to be incorporated into the primary legislation,
the site is worth exploring.

Age boundaries
Various orders available under the Children Act 1989, as amended, provide
for a maximum duration that is usually defined by the age of the individual.
This can be at age 16 or 18 years of age and decisions may be brought to an
end by court order, variation or discharge and made subject to additional pro-
visions. To give two examples: Parental Responsibility Orders generally last
until 18 years of age while Contact Orders generally last until 16 years of age.

Parental responsibility (for children)


Parental responsibility for children is a specific aspect of the Children Act
1989 with which practitioners working with children and young people
should become acquainted. Section 3(1) of the Children Act 1989 defines
parental responsibility as: ‘All the rights, duties, powers, responsibilities and
authority which by law a parent of a child has in relation to the child and his
property’. These are intricate but parental responsibility (PR) is central to
practitioners’ decision-making process in relation to accepting new clients
and in communicating with parents, guardians and carers.

To illustrate, I recall Sarah (aged 7), whose mother asked me to undertake some
work with her arising from her parents less than amicable separation. I decided
it would be appropriate to see both parents initially since – as I then thought – it
would be to Sarah’s benefit that her parents were demonstrably supportive of her
having therapy. I also felt that the absence of joint support could be detrimental
for my work with Sarah since she might find that meeting with me could not only

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Aspects of the Law in Child-centred Therapy  183

intensify the existing animosity between her parents but also cause her to feel the
disharmony was in some way her doing. All in all I believed the active participa-
tion of both parents would be beneficial.
Arranging the initial intake appointment was itself challenging and in the
event I provided two intake sessions – one with each parent. It soon emerged that
while Sarah’s mother was keen for her daughter to meet with me, her father was
less well disposed towards the idea. At intake I established that Sarah spent half
her week with one parent and the remainder with the other. When factoring in
such requirements as school holidays, childhood illnesses, the holiday entitle-
ments of both working parents, and so on, the arrangements were complicated
and both sets of grandparents actively participated in Sarah’s care.
I first met Sarah with both parents, and a block of six sessions was agreed.
Each parent agreed to alternate the task of bringing Sarah to her appointments
but, in the event, her mother brought Sarah to all six sessions. At the conclusion
of the subsequent review appointment, Sarah’s father decided he did not want her
to continue with therapeutic support whereas her mother disagreed.
I was in a dilemma, having initially explained that I would find it difficult to
work with Sarah unless both parents supported her therapy, her father was now
withdrawing his support. At the same time, Sarah’s mother wanted her daughter to
continue – as did Sarah herself. I felt ‘trapped’ by my own reasoning and I sought
legal advice. I was told that since Sarah’s mother was responsible for bringing
Sarah to therapy during the half of the week, when she was with her mother, I was
on safe grounds (in this instance) to continue meeting with Sarah. Such a decision
would need me to abandon my view that Sarah’s interests might be better served
by the participation of both parents. Having reflected, I decided to continue meet-
ing with Sarah, thus incurring her father’s concern. I found this hard to manage but
at least no longer felt trapped by my own principles. I then began to appreciate
that my experience represented, in a modest way, something of the feelings with
which Sarah struggled when she felt caught between her parents.

The relevant legislation advice was the Children Act 1989, Part I, Section 2(7):

Where more than one person has parental responsibility for a child, each of them
may act alone and without the other (or others) in meeting that responsibility; but
nothing in this Part shall be taken to affect the operation of any enactment which
requires the consent of more than one person in a matter affecting the child.

I now take the view that while it is desirable for both parents actively to
participate in their child’s therapy, I accept there will be occasions when this
might not be possible.

Exercise

With reference to Sarah’s story, identify the issues and consider in detail both the
merits and demerits of parental participation in a child’s therapy.

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184  Person-centred Therapy with Children and Young People

Acquisition of parental responsibility by the father


A father who is not married to the mother of his child has no parental
responsibility but he can acquire it in a number of ways described in Section 4
of the Children Act 1989. Part I of the Children Act 1989 also includes provi-
sions for acquiring parental responsibility by a second female parent and by
a step-parent. Under Section 2(1), a father automatically has parental respon-
sibility for his child if he was married to the child’s mother at the time of the
child’s birth. The Family Law Reform Act 1987 enables a child’s father to
gain parental responsibility if he subsequently marries the child’s mother
after conception or the birth of the child. A married man has no parental
responsibility for children who are not biologically his own, even if they are
born during the marriage. Children born to a married couple as a result of
artificial insemination will be regarded as the child of the husband, provided
that the conditions set out in the Human Fertilisation and Embryology Act
1990 are met.

Parental responsibility and medical consent


Parental responsibility lasts until a child is 18 years old. Other than in emer-
gencies, no person in that age group may be given medical treatment without
consent (subject also to the next paragraph). Those with parental responsibil-
ity, or a court, can give consent for medical assessment and/or treatment. In
emergencies, an appropriately qualified doctor may lawfully treat a child.
With unmarried parents, in the absence of a parental responsibility agreement
or other appropriate legal determination, only the mother will have parental
responsibility for the child. Single parents should appoint a guardian for their
child or children since, in the event of the death of any lone parent with paren-
tal responsibility, there will be no one with parental responsibility for the
child. Parental responsibility always belongs to a mother in relation to the
children to whom she has given birth, irrespective of whether she is married
to the father of the child or to anybody else or not.
Broadly, the provisions for gaining informed consent to treatment (and by
implication assessment and examination) for young people aged 16 and over
will be the same provisions as for adults. In 1985 a judgment (Fraser ruling)
that became known colloquially as ‘Gillick competent’ concerned the provi-
sion of a local health authority’s contraceptive advice to a girl aged under 16
without her mother’s consent. The formula provided a basis upon which
children under the age of 16 may make medical decisions. The Fraser ruling,
made by the House of Lords in the case brought by Mrs Gillick (Gillick, 1985,
3 All ER 402), permitted doctors to provide medical treatment to children
under the age of 16 without parental consent. The Fraser Guidelines of 1985,
as stated by Lines (2006: 24), ‘gave general (medical) practitioners the right
to give contraceptive advice to young people under the age of 16 without
parental permission, if the child so wished. The only requirement was that
the doctor should strike a balance, when arriving at a judgement, between

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Aspects of the Law in Child-centred Therapy  185

the protective wishes of the parent and the considered consequences of


informed consent – measured by the age, intelligence and maturity of the indi-
vidual.’ Mitchels (2009: 120) states that such decisions will be according to
‘chronological age, considered in conjunction with the child’s mental and
emotional maturity, intelligence, and comprehension’ of the nature and con-
sequences of the decision to be made and the quality of the information
provided.
Where immediate action is needed for the welfare of a child and no one
with parental responsibility is available, Section 3(5) of the Children Act 1989
provides that:

A person who, (a) does not have parental responsibility for a particular child; but
(b) has care of the child, may … do what is reasonable in all the circumstances
of the case for the purpose of safeguarding or promoting the child’s welfare.

This may apply to practitioners and others looking after children needing
emergency advice, such as taking a child urgently to be seen by a GP. This
section does not cover the matter of consent for immediate medical care.
When practitioners work with a child they are legally responsible for look-
ing after that child; this must override the conceptual notion of equality
within the therapeutic relationship. It is incumbent upon the practitioner to
take all reasonable steps to be acquainted with a child’s medical history and
needs. In the event that an emergency arises, the practitioner should know
what action to take and how this will be achieved. Practitioners working in
organisational settings such as schools should read the organisation’s health
care plan in relation to the provision of emergency assistance. In 2010 two
teachers were suspended after an inquest into the death of an asthmatic
pupil aged 11 determined that their failure to act was probably a factor in the
child’s death. It is understood that currently there is no legal duty requiring
teachers to help children manage their medicine or medical conditions,
although it is known that many staff may do so on a voluntary basis perhaps
as a result of having received some training. Moreover, the employment
status of volunteer or student practitioners working in schools, clubs, etc.,
can often be unclear and individual therapists should be cognisant of their
responsibilities within their setting. Asthma UK advises that a school’s duty
of care to pupils means that staff act like any ‘reasonably prudent parent’.
Independent practitioners can expect to provide at least a similar level of
support to their clients.

Exercise

In your work organisation, critically assess your responsibility for the children
with whom you come into contact. Is it that of the ‘reasonably prudent parent’
and, if not, what improvements would you need to make or recommend?

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186  Person-centred Therapy with Children and Young People

Joint registration of the birth by father and mother


Joint registration of the birth by father and mother is included under the
Adoption and Children Act 2002 provisions and applies to registering births
made on or after 1 December 2003. The birth of a child born before this date
can be re-registered where the original registration did not name the father,
provided the requirements of the Births and Registration Act 1953 are met.
In 2008 the Department for Children, Schools and Families published Joint
Birth Registration: Recording Responsibility and stated: ‘Every year up to
45,000 birth registrations in England and Wales do not include the name of
the father’ (2008a: 3). An unmarried father’s name is only recorded at the
outset if both parents agree. For joint registration, both mother and father
need to be present at the Register Office to sign the register. One parent may
register and provide either a statutory declaration of parentage, signed by
both parents and witnessed by a legal representative, a jointly made parental
responsibility agreement, witnessed by a magistrate or officer of the court
and registered in court, or a court order. The government planned to require
unmarried parents to jointly register the birth of their children and cited
studies by Pleck and Masciadrelli (2004) and also McBride, Schoppe-Sullivan
and Ho (2005), who provided evidence on the positive contribution paternal
influence can make to the well-being of children. In the event, it seems this
proposal – giving a father a new right to insist he is registered – never
reached the Statute book.

I think of Darren (aged 10), who went to live with his maternal aunt two years
earlier following a breakdown in the relationship with his mother. It emerged that
when Darren was born his mother was so angry with his father that she refused
to have the father’s name entered on Darren’s birth certificate. Darren wanted a
relationship with his father, but felt ‘fobbed off’ by his mother. When, at the age
of 8, he found that his father’s name was not registered, Darren’s relationship with
his mother rapidly deteriorated.

Exercise

What are your feelings about the joint registration of births from a child’s perspective?
Is it reasonable for a child to want to know who his/her father is and under what
circumstances would it be appropriate (if at all) to deny a child that information?

Family proceedings
Family proceedings are stated to be non-adversarial since they are con-
ducted with the overriding objective of reaching decisions deemed to be in
the best interests of the child. The court does not concern itself with whether

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Aspects of the Law in Child-centred Therapy  187

or not the decision is particularly favourable to one party or the other (Bond
and Sandhu, 2005). However, ‘non-adversarial’ is a relative term – it is com-
pared with the litigious process of the criminal courts where the burden of
proof is higher than in family courts. Parents who have been party to family
proceedings have told me of their deeply held feelings that proceedings
were rather more adversarial than family orientated.
Gathering information in individual cases is comprehensive and there are
recognised procedures for interviewing clients for information required
from parents as well as medical witnesses. In child law the focus is placed
upon the welfare of the child (not specifically emotional well-being) and in
child protection, the burden of proof is on a balance of probability, when it
is necessary to establish that it is more likely than not that there is an actual
or risk of significant harm to the child.
Section 8 of the Children Act 1989 creates orders (Contact Orders, Prohib-
ited Steps Orders, Residence Orders and Specific Issue Orders) that are
available to the court in family proceedings. Practitioners may come across
Contact Orders and Residence Orders, so I have summarised these below:

•• Contact Order – an order requiring the person with whom a child lives, or is to live,
to allow the child to visit or stay with the person named in the order, or for that
person and the child otherwise to have contact with each other.
•• Residence Order – an order settling the arrangements to be made as to the person
with whom a child is to live.

The Family Procedure Rules 2010 (FPR), which came into force in April 2011,
provide a single set of rules for proceedings in the magistrates’ and other courts
along the model of the Civil Procedure Rules 1998. This guidance is intended to
provide one set of ‘simply expressed’ rules of court for family proceedings. How-
ever, it comprises almost 300 pages of Statutory Instrument and 36 parts. Part 12
(comprising seven chapters) deals with the bulk of children matters, essentially
all those excluding adoption and placement as well as matters concerned with
the Human Fertilisation and Embryology Act 2008. Part 16 comprises 14 chapters
and concerns the representation of children and reports on children.

Child and Family Court Advisory Support Service


The Child and Family Court Advisory Support Services (CAFCASS) was
established in 2001 following radical changes to the family court advisory
system. The functions of CAFCASS are to:

•• Safeguard and promote the welfare of the children in family court proceedings
•• Give advice to any court about an application made to it in such proceedings
•• Make provision for children to be represented in such proceedings
•• Provide guidance and support for children and their families.

CAFCASS officers have different roles in private and public law proceedings
as Children’s Guardians, Parental Order Reporters and Children and Family

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188  Person-centred Therapy with Children and Young People

Reporters. Ministry of Justice statistics show that 25,810 children were


involved in public law care applications in 2009, compared with 19,760 in
2008, and that cases took, on average, 56 weeks to conclude. A current
review is considering possible improvements to the family justice system.
Family Justice Review Interim Report (March 2011) stated: ‘The number of pri-
vate law cases coming to court have been rising since 2005, with a jump in
2009 when 137,000 children were involved, up 14% compared to the previ-
ous year. The reasons for this are unknown, though the recession may have
increased family strains’ (Ministry of Justice, 2011: 47, paragraph 2.36).
From time to time I provide therapeutic support to a child who is cur-
rently or who may become associated with CAFCASS proceedings. Simi-
larly, I may see adult clients who are already, or who are likely to become,
involved in family court proceedings involving CAFCASS officers who
undertake welfare reports about their offspring in their capacity as Children
and Family Reporters. These procedures relate to applications in Section 8 of
the Children Act 1989 with regard to private law proceedings, including
applications with respect to residence and contact. More recently, CAFCASS
officials work with families at the stage of initial application to the court.
Occasionally a CAFCASS officer may contact me for my views on family
circumstances. Such conversations can be helpful to my clients and my con-
tact with officers has parental consent and/or the agreement of the young
client. I feel that the therapists and other professionals who work closely
with children whose needs are the subject of CAFCASS involvement should
routinely be contacted for their perspective and input in individual cases in
a timely and relevant manner. Currently, this does not happen and unless the
Court orders a report, the comments of other professionals may or may not
form part of the CAFCASS report for the Court.

Children affected by divorce or separation


This represents a significant proportion of family referrals to my practice.
Children may be struggling with the consequences of marriage or rela-
tionship breakdown or a parent who feels unable to have an appropriate
relationship with their child following the ending of a marriage. Children
of divorced or separated parents normally reside with their mother and
the father with parental responsibility has access by arrangement with the
mother of his children. However, I should point out that there are excep-
tions to this arrangement, where residency is given to the father and the
mother is the non-resident parent. When parents are unable to make con-
tact arrangements by mutual agreement this may be resolved through
mediation but sometimes, when this fails, the matter may be referred to
the court for decision.
So-called amicable arrangements are made between parents for access to
children without the need for costly litigation but significant complications
can arise. For example, there is nothing in law to prevent a mother moving

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Aspects of the Law in Child-centred Therapy  189

with her children to a part of the country making it difficult for a father to
achieve the agreed contact arrangements (or vice versa). This raises further
problems for non-resident parents who may, by virtue of the travel distance,
be unable to attend school activities in which their children are involved and
be part of other events at which their children might appreciate their pres-
ence. In the instance of a parent who seeks to relocate abroad with offspring
when the other parent objects to the children emigrating, the relocating par-
ent must seek ‘leave to remove’ from the courts.
Relocation and the court’s precedent was last reviewed in 2001 (Payne v
Payne [2001] EWCA Civ 166). In that case, the barrister for the father argued
that ‘the importance of contact between the non-resident parent (normally
the father) and the child has greatly increased over the last thirty (now forty)
years. Lord Justice Thorpe, the leading judge in Payne v Payne held that “No
authority for the proposition is demonstrated. Without some proof of the
proposition I would be doubtful of accepting it.”’ It is understood that the
child lost contact with his father and ten years on, ‘contact in New Zealand
did not take place’ (Family Law Week, 2010).
In November 2010 the publication Family Law: Relocation – The Case for
Reform (Custody Minefield in cooperation with Families Need Fathers, 2010)
stated:

Courts must adhere to a view, first expressed in the 1970s, that to deny a mother’s
application to relocate will cause her such psychological harm that it impacts on
her ability to provide care. This is commonly referred to as the ‘distress argu-
ment’. The court, in practice, holds the view that the mother’s distress will be as
great or a greater factor than the child’s distress in terms of losing a relationship
with their other parent (or that relationship being severely diminished), the loss
of contact with their extended family, removal from school and the loss of rela-
tionships with their established friends.

In a June 2010 case, AR (A Child: Relocation) [2010] EWHC 1346 (Fam), Mr Justice
Mostyn QC articulates this point when he said: ‘Indeed there is a strong view
that the heavy emphasis on the emotional reaction of the thwarted primary
carer represents an illegitimate gloss on the purity of the paramountcy principle
[that child welfare must be the court’s paramount consideration]. Moreover,
some argue that it promotes selfishness and detracts from the importance of co-
parenting.’ Nevertheless it seems he accepted that his opinion could not over-
rule the Court of Appeal’s precedent that he, like other judges, must follow.
Kruk (2008: iii, paragraph 1) says in Canada:

Sole maternal custody often leads to parental alienation and father absence, and
father absence is associated with negative child outcomes. Eighty-five per cent of
youth in prison are fatherless; 71 per cent of high school dropouts are fatherless;
90 per cent of runaway children are fatherless; and fatherless youth exhibit higher
levels of depression and suicide, delinquency, promiscuity and teen pregnancy,
behavioural problems and illicit substance abuse.

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190  Person-centred Therapy with Children and Young People

When parental breakdown causes conflict and the emotional well-being of


the children is not paramount, the scope for emotional harm can be
immense. This may frequently, but not exclusively, adversely affect the
relationship between children and the non-resident parent. Consider, for
example, the circumstances in which a mother may be, for whatever rea-
son, instrumental in ending a relationship in which the man has been a
devoted husband and father. She gains residence of the children and
arrangements are made for the non-resident father to have regular access
on a jointly agreed basis. It might be expected that the commitment to
honour a joint agreement will necessitate both parents communicating
and smoothing the way for their children to have an appropriate relation-
ship with the non-resident parent. When this does not work the resulting
conditions can give rise to emotional pressure for both children and non-
resident parent.
Fabricius (2003: 390) says in his summary of parent undermining:

Children can become angry at a parent for interfering with their time with the
other parent. When they perceive that a parent interferes, they also tend to per-
ceive that parent as criticizing the other parent as not wanting the other parent
involved in their lives. The more they experience these undermining behaviors
and attitudes, the worse they report their relations with that parent to be years
later, especially for mothers.

Children may feel they are a ‘pawn’ in the continuing disagreement between
their parents and inherent animosity might pressure them also to take sides.
A parent with residence might make it awkward (or appear to make it awk-
ward) for children to have quality time with the non-resident parent. Chil-
dren are highly sensitive to the feelings of significant people in their lives
and great care is needed by both parents to ensure that – whatever the cir-
cumstances of the relationship breakdown – they do all they reasonably can
to maintain the emotional support needed by their children.
Children can become subjected to a division of loyalties which may
impose considerable pressure and lead them to feel responsible for ensur-
ing harmony between their parents. Indeed, children may continue to want
an equal relationship with each parent, but when the resident parent is
meeting most of the children’s daily needs it is hardly surprising they may
feel a sense of duty to their primary carer. In these conditions some children
might find they need to ‘marginalise’ the non-resident parent since it can
then enable them to diminish the fragility of their compartmented reality
(see Chapters 5 and 6). When asked, some children might therefore be
expected to express the view that they want little to do with the non-resi-
dent parent and, when taken on face value, it might appear that this is how
they truly feel.
If these views could be explored more thoroughly, a different feeling may
be revealed, one that may be desired by the child but which he/she knows is
unlikely to happen – that the parents at least get on better with each other. To

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Aspects of the Law in Child-centred Therapy  191

avoid the rejection of their feelings, children might therefore select an option
that is more likely to be approved of and validated by their primary carer –
perhaps without the primary carer explicitly communicating to the child the
options and their implications. The loving non-resident parent may feel the
primary carer has put children ‘up to it’ even if that is not the case and such
a parent is bound to experience their children’s rejection as hurtful and dis-
tressing. Rejected non-resident parents should do their utmost to have an
open, if one-way, contact with their children so that parental unconditional
acceptance can be maintained. It is unimaginably tough for a caring non-
resident parent to cope with this and it is understandable that some will feel
so weakened by the experience they ‘walk away’. Children whose rejecting
behaviour results in this outcome have achieved what – on one level – they
set out to do since they can then, with apparent justification, claim their non-
resident parent walked out on them. The non-resident parent becomes the
villain and the child’s attitude may thus appear to be vindicated.
Fabricius (2003: 394), in his conclusion, says:

The more students [his research group] perceived a parent engaging in undermin-
ing behaviors and attitudes, the less time they perceived that parent wanted them
to have with the other parent. The more time they wanted with their fathers, the
more they perceived their mothers interfering with that time. They saw mothers’
desire to have the children with her as a primary reason they did not have more
time with their fathers, and they expect that it is the norm for mothers and fathers
to disagree about living arrangements.

For contact arrangements to work effectively, both parents need to maintain


a level of facilitative communication, recognising that there will be occasions
when, for instance if a child is unwell, that the plan will be disrupted. It is
incumbent on both parents to ensure contact is as seamless as possible and
that children are able freely to enjoy quality time with both parents. Pro-
vided that contact arrangements are thoughtfully planned, children will
move relatively freely between both parents, thus affording children
improved emotional stability.
In my experience, significant problems arise when parents do not provide
clarity for their child. A non-resident father agreed to spend Sunday with his
daughter, Rachel (aged 3), and then he failed to show up.

From Rachel’s point of view she had known for some days that the visit had been
scheduled and her mother had helped her prepare for the visit (the first in two
weeks). Rachel was really looking forward to it. On the day, Rachel was dressed
ready for her day out and was by the window eagerly awaiting her dad’s arrival
(Figure 13.1). Twenty minutes after he should have arrived, Rachel’s father tele-
phoned her mother to say something had come up, the visit was off and she
should explain the situation to Rachel. This was not the first time Rachel’s dad had
done this and she was extremely upset at being let down yet again.

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192  Person-centred Therapy with Children and Young People

Figure 13.1  W
 aiting at the Window – a child’s sad interpretation of
waiting for the arrival of someone he loves

Similar difficulties arose when Rachel, who had become gradually used to the
timetable of her father’s visits, found he would turn up unexpectedly at times
other than those pre-arranged, anticipating that she would readily give up what
she was doing for his benefit. This loss of certainty for Rachel led to her reality
being compromised and increased her insecurity. Apart from upsetting Rachel’s
equilibrium, she became angry with her dad for the distress he had generated
without, it seemed, his awareness or regard for her feelings. From a child’s per-
spective, clarity of arrangements is necessary to help him/her to accommodate
what they feel to be inherently unnatural.

Exercise

What attributes are to be found in parents who, despite divorce or separation,


have full regard for the emotional well-being of their children? With reference to
the legislation described in this chapter, to what extent do you feel the law
genuinely places the needs of children first?

Legal proceedings and therapy


When asked to meet with a child whose parents are in the course of legal
proceedings in relation to residence and access, I need to ascertain

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Aspects of the Law in Child-centred Therapy  193

that providing therapy will not impede the legal process. Obtaining this in
writing from both parents through their legal advisers hopefully avoids the
possibility – however slim – of being in contempt of court. Having the con-
sent of parents to speak to their solicitors, I will seek formal agreement for
the therapy to take place. Without formal agreement I am unlikely to accept
the referral.
Therapists working with children who are victims and witnesses of crime
may also have to deal with the experience of coming into contact with law
enforcement agencies and those agencies taking action (or not) against their
offender. Bond and Sandhu (2005: 81) suggest this ‘can be described as sec-
ondary victimisation at the hands of the legal system. Even where therapists
attempt to help clients in addressing and resolving these problems, their
efforts are hampered by the constraints of legal rules relating to the contami-
nation of evidence.’ To a young victim, the judicial process may reinforce a
sense of powerlessness that was first experienced during the crime that has
subsequently led to legal proceedings.
It is also possible that a decision not to proceed with a case involving a
child victim or witness can give rise to powerful feelings within that child.
Reasons for not proceeding may include doubts about the likelihood of
securing a conviction or to protect the child from encountering the legal
process. Apart from feeling severely let down by a system that is intended to
protect, such a decision may serve to further compound an already
immensely distressing experience. Victoria (aged 17) wrote the following
some four years after the legal system determined not to lay criminal charges
following sexual abuse by her uncle:

Personally I feel let down by the legal system and I don’t feel as if justice has been
served. For me the legal system seems to go too far the wrong way and takes the
offenders rights and needs above the victims. For me they worry too much about
being ethical to the offender rather than making sure punishment is served for
committing a crime, no matter who has committed it. Yet if I was to get revenge
and seek out my own justice because I feel as if justice hasn’t been served, I
would be put in prison straight away no doubt about it. The fact that one person
gets to make the decision whether or not a person is ‘fit’ for court based on a few
meetings with that person doesn’t seem right to me. They are unable to gain
insight into the whole picture and they get a snapshot view of a person and I
personally believe that my uncle was smart enough to make his condition seem
worse than it actually was, and for that my case didn’t even get to court for a jury
to decide whether or not he was guilty. He got away with committing a serious
crime, his lifestyle hasn’t changed at all, none of the people close to him that
spend time with him know what he did and he is still allowed to be around
children but he has to be supervised, but ‘supervision’ was only six feet away
from me and he still managed to do what he did, he doesn’t have to live with
what he has done, but I have to for the rest of my life, I have to carry that with
me, my world has been changed for ever and his was hardly even disrupted.

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194  Person-centred Therapy with Children and Young People

I also recall a 15-year-old girl, with whom I did some work, who subse-
quently disclosed to her mother that her step-father had sexually abused
her and at least one of her younger sisters. The youngest sister was the
biological daughter of the alleged perpetrator and when a decision was
taken not to proceed with charges, not only did my client feel immense
anger at her step-father ‘getting away with it’ but, having been forced to
leave the family home, he planned to apply for residence of his youngest
daughter. Under certain circumstances, the void left by a decision not to
prosecute can be immense and cause lifelong problems, including contempt
for the law.
Bond and Sandhu (2005: 83) comment: ‘Child witnesses have sometimes
been denied access to therapy if a prosecution is pending. Some therapists
have avoided such work because of fears that their notes may be subject to
a court order, or that they themselves may end up having to give evidence
in court about their work with the child.’ There is a view that work is inef-
fective prior to trial and that any progress made would be ‘undone’ by the
legal proceedings. More commonly, therapists are ‘anxious not to prejudice
the evidence the victim will be giving. Discussions about the content of evi-
dence prior to trial may give rise to (legal) questions about the validity of the
victim’s evidence’ (Bond and Sandhu, 2005: 83). If a prosecution fails because
the validity of the evidence is undermined, such a decision can have signifi-
cant effects upon the child. It is also possible that delaying therapy for a
child until after a trial’s completion may adversely affect his or her emo-
tional well-being.
Care is needed in reaching a decision to commence therapy and the
Crown Prosecution Service (CPS) can be contacted about the likely effect of
therapy on evidence to be presented at court. Subject to CPS agreement in
each individual case, I feel child-centred therapy can safely enable child
witnesses to explore their personal process without direction, thus ena-
bling them to achieve greater self-understanding and self-confidence with-
out prejudicing evidence subsequently to be given in court. According to
Bond and Sandhu (2005: 86): ‘Limited therapy, which does not involve
going over the crime and focuses on building the client’s self-confidence,
could be used before the trial, leaving other more “penetrative” forms of
therapy until the trial has ceased.’ Inexperienced practitioners must not
undertake therapeutic work with children likely to be a witness in legal
proceedings. In 2001, the Home Office, the Department of Health and the
CPS jointly issued guidance (Provision of Therapy for Child Witnesses Prior to
a Criminal Trial) in response to the dilemmas briefly mentioned above and
concerns about the length of time child victims wait before gaining access to
counselling therapy. Bond and Sandhu (2005: 84) say: ‘It is a means of over-
coming the perceived conflict between providing pre-trial therapy to assist
children and tainting the evidence, and is useful for therapists as it sets out
a framework for good practice, while trying to ensure that standards of
evidence required by the courts are met.’

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Aspects of the Law in Child-centred Therapy  195

Exercise

A girl (aged 14) is sexually abused by a known family member. Some weeks later,
she tells her mother who then contacts the police. After a short investigation, it is
decided that it would not be in the girl’s interests to pursue a criminal prosecution.
Identify the likely feelings of both the girl and her mother.

Summary
This chapter touches upon some of the pertinent legislative matters encoun-
tered in working with children and young people. In child-centred practice,
therapists may come into contact with aspects of family law and familiarisa-
tion with some of its key features is recommended. Maintaining up-to-date
knowledge of the law and its intricacies is a minefield and practitioners
should not venture far without experienced expert guidance.
Divorce and separation are major life events for children and, when work-
ing with children and young people affected in this way, the complexities
can have profound effects upon their emotional development and well-
being. Individual therapists are required to operate within existing frame-
works but it can be challenging for practitioners to ‘accompany’ clients who
are entangled in a process that appears to be unfair to both young clients and
affected parents.

Suggested further reading

Bond, T. and Sandhu, A. (2005). Therapists in Court: Providing Evidence and Supporting
Witnesses. London: Sage.
Fabricius, W. V. (2003). Listening to children of divorce: new findings that diverge from
Wallerstein, Lewis and Blakeslee. Family Relations: Interdisciplinary Journal of
Applied Family Studies, 52(4): 385–96.
Kruk, E. (2008). Child custody, access and parental responsibility: the search for a just
and equitable standard. (Commissioned by the Father Involvement Research Alliance
based at the University of Guelph.) Vancouver, BC: University of British Columbia.
McBride, B. A., Schoppe-Sullivan S. J. and Ho, M. H. (2005). The mediating role of
fathers’ school involvement on students’ achievement. Applied Developmental
Psychology, 26: 201–16.
Mitchels, B. with James, H. (2009). Child Care and Protection: Law and Practice.
London: Wildy, Simmonds and Hill Publishing.

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Conclusion

Having reached this stage in my book, I recall its genesis and how impor-
tant it was to me to try to convey what I believe to be the essence of being
person-centred. I think of the tensions this approach has encountered
along its evolutionary way. In the early days, it was trivialised by many
who thought it was simply a matter of repeating the last remarks of a cli-
ent. At the same time, Rogers came into conflict with practitioners in
other branches of psychotherapy when he stated that, given the means to
flourish, clients knew what they needed for themselves. It was the role of
the expert practitioner to point out where clients were going wrong and
to teach them what they must do in order to correct their difficulties.
Moreover, it was evident even to its architect that mere words could not
satisfactorily explain the process of the person-centred relationship.
When Rogers attempted to describe aspects of this human relationship at
its deepest levels, he recognised that words were not enough. Other
things were taking place in the therapeutic relationship that appeared to
defy description. It had to do with a sense of being – a sense of inner
knowing.
In this age, too, person-centred practitioners will encounter similar experi-
ences that question the integrity of the approach. Surely no right-minded
person really believes that individuals (let alone children and young people)
are capable of being their own experts. If the benefits of the person-centred
approach cannot be codified and narrowly specified outcomes routinely
replicated, then it is somehow unlikely to provide an adequate evidence
base and is thereby dismissed. Practitioners embody the essence of the per-
son-centred modality, reflecting our individuality towards another who is
also an individual. This is no less true of the child-centred therapist.
I am not a ‘technician’ therapist, for I do not feel I have been taught to
do this work. If anything, I have had to do a great deal of unlearning accu-
mulated over some four decades. Until I started as a practitioner, I
believed learning was something that came from people more knowledge-
able, the need to absorb texts written by experts in the field and through

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Conclusion  197

participation in a mechanistic training approach. After all, this was a kind


of education so familiar through my childhood, teenage years and beyond.
I was used to looking beyond my self for guidance, unable to realise that
I had within me a resourcefulness that, given the opportunity, could be
harnessed and utilised in the service of my clients. It was certainly a prime
example of Rogers’ views on the locus of evaluation – mine was almost
entirely externally developed, feeling that my internal evaluative process
was virtually non-existent.
I therefore hope readers will be encouraged to use this text to find what
being person-centred or, more specifically, child-centred means for them. As
practitioners we need to be open to our experience so that we can be truly
present for our clients. If we believe in the equal nature of the child-centred
relationship, then we must be open to the entirety of our experiencing to
enable us to be wholly present for younger clients. If our process is blocked
by personal values and experiences that we are unable or unwilling to tran-
scend, then we will find it hard to hide this from our clients even if we may
want them to feel they can ‘tell us anything’ without fear of being judged.
The limitations of space have not permitted me to explore in any depth,
child-centred practice within organisations. Chapter 12 has sought to offer
a brief perspective of multidisciplinary working in a school environment.
Being a practical person at heart (it was the only alternative for someone
whose academic skills were limited), I wanted to describe how child-centred
therapy effectively translates to a school setting with all the attendant
complexities of a triangle of relationships – pupils, parents and teachers.
I believe a child-centred practitioner can be an effective member of a
managed therapeutic team but the practitioner may need to adjust periph-
eral aspects of his/her being to accommodate the needs of the organisation
within which practice is to take place. Moreover, I hope those responsible
for managing services can be open to the possibility that a child-centred
practitioner may be a strong member of a team otherwise populated by
practitioners from other approaches.

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