PrefaceIn this short preface, which serves an introduction to the book, we will be clear about our focus in the book, the audiences for the book, and our theoretical foundation for the empirical research contained in the chapters. Here we will explain that our focus on families is those families that have a child, under the age of 18 years in the interaction, rather than being on adult family interactions.
PART ONE: THEORETICAL CONTEXT
1. Systems within systems: Families in societya. This chapter sets the theoretical foundation for the rest of the book. All other chapters are primarily practical, but will draw upon the theoretical framework introduced in this opening chapter. We position the practical and empirical findings from our research into mental health interventions with families and children, in relation to the integration of social ecological theory, systems theory and social constructionism. Each of these theoretical frameworks will be briefly outlined and their intersection will be described to provide readers with a clear understanding of where mental health family conversations are societally situated. Different explanations of normality have different trajectories for the direction of our understanding of mental health and illness. Thus, this chapter will cover: i. The language of mental health and illness ii. The language of deviance iii. Social ecological theory iv. Systems theoryv. Social constructionism vi. Biomedical and social explanations of mental health vii. Political systems, health systems and the Western context (including UK). viii. How these ideas are integrated to present our position through the book 2. Communicating with families a. Bearing in mind the wider context outlined in chapter one, and the debates around normality and it biomedical or social underpinnings, we move in this chapter to the history of how family interventions have become an important part of the institutional landscape for working in child mental health. We discuss what family therapy is, and the different kind of work with families (such as mental health assessments). Thus, this chapter will cover: i. What constitutes the family - Western context ii. What constitutes the family - other cultures - we will use real world examples iii. The modern diverse family - including boxes of lived experience - to include new ways of thinking about the family (same sex couples etc)iv. Family interventions - family therapy (and its history), mental health assessments v. Introduce research projects that chapters are based on vi. Introduce language-based approaches to research and analysis (Conversation analysis and discourse analysis, e.g., the social action of language - performative discourse) 3. Forming and maintaining good therapeutic relationships a. Language-based therapy relies heavily on the relationship between all parties involved. It is crucial to understand how to develop mutual relationships and to maintain them without encountering rupture. When rupture does occur, the professional needs communication strategies to 'fix' the rupture. The language and communication are thus the cornerstone of the intervention. Thus, the chapter will cover: i. The importance of the therapeutic relationshipii. Language as a vehicle for change iii. Alignment in multi-party conversations iv. Rupture v. Who takes responsibility to fix a rupture and how?vi. Data examples
PART TWO: ENGAGING CHILDREN 4. Managing interruptionsa. In the context of multi-party conversations, it is common to find that people may overlap in talk or interrupt one another. This chapter looks at what the social meanings and functions of interruptions are in the context of child and family mental health interventions. Thus, this chapter will cover: i. What constitutes interruptions - interruptions as a social construct ii. Questioning the notion of power in interruptions iii. Politeness markers and their role iv. Children's interruptions and their treatment in the conversation v. Therapists' interruptions vi. Parents' interruptions 5. Engaging children through questions a. This is a very practical chapter that draws upon previously published empirical research exploring specific techniques used to engage children in therapeutic conversations. While lots of information about the child can be gathered from other family members, it is important for professionals to find ways to communicate directly with children to ascertain their thoughts and feelings. Thus, this chapter will include: i. The importance of question design ii. You said prefaces; using the phrase you said as a preface to introduce difficult topics iii. Three wishes; using the phrase 'if you had three wishes' to elicit goals from children in therapy or assessments iv. Why are you here? Establishing the extent children understand their attendance in the mental health setting v. Using why questions 6. Engaging children through creative techniques a. This is a very practical chapter that draws upon empirical research and the wider literature to explore creative techniques, such as play and art used to engage children. Thus, this chapter will include: i. The importance of participatory techniques - creative and visual (art and play) ii. Subjective Units of Distress as a quantitative measure of children's feelings (e.g., on a scale of one to ten) iii. The use of art, play, drawing family trees, role play through television programmes etc (mostly drawn from the literature)7. Children's competence a. This chapter specifically focuses on children and young people, and how they are treated in multi-party, multi-generational interactions in mental health environments. What is negotiated in these interactions is the competence of children to be able to answer questions asked of them and provide reliable information about their wellbeing. Thus, this chapter will include: i. The socially constructed nature of competence ii. Expectations adults have of children and how they are aligned with or contested by the children in these settings iii. Relevance of children's developmental age iv. Therapists' competence and cultural competenciesv. The types of question adults ask of children and assumptions made about whether they are competent to answer vi. The notion of children holding half-membership in adult conversations and its relevance in mental health vii. Data examples
PART THREE: ATTENDING TO THE DIFFERENT NEEDS OF FAMILY MEMBERS 8. Managing sensitive conversations with children presenta. Through the course of multi-party conversations there are likely to be instances where members treat the topic or content as in some way inappropriate or difficult for one of more of the people present. This is particularly the case where adult may be talking about topics that they orient as being inappropriate to discuss in front of children. In situations where one person is talking about another present party, the talked about person may choose to disagree with the appraisal. Thus, this chapter will cover: i. Determining the appropriateness of adult topics while children are in the room. ii. The social construction of the adult and of the child - and the social construction of what topics are categorised as 'adult' iii. Managing the delicacy of what might be socially determined as an adult topic but may be relevant (or not) to the child iv. Managing topic choice in multi-party and multi-generational interactions v. Managing disagreement between parties vi. Data examples 9. Avoiding shame and blame a. In multi-party conversations, and especially in settings like family therapy, an understanding of the child's difficulties is positioned as being to some extent the responsibility of the parents. This positioning means that parents often need to do discursive work to construct themselves as good parents. This identity construction deflects blame for the child's difficulties. i. Parents positioning as responsible for the child's difficulties ii. A social construction of a systemic dysfunction in separated and blended families.iii. The management of blame and accountability iv. Identity construction and subject positions v. Data examples 10. How to talk about risk a. This chapter addresses the important issue about how risk is assessed and discussed in multi-party conversations in mental health settings. Where frequently self-harm and suicidal ideation are found to be present in those with mental health need, and therefore it is important to explore this difficult topic. Nonetheless mental health practitioners may find talking about risk, especially with children and young people, a challenging endeavour. We discuss useful techniques that mental health practitioners can use to facilitate these conversations. i. The context of self-harm, suicide and mental health ii. Regulatory requirements to assess for risk iii. The challenges of eliciting information about sensitive topics iv. Communication techniques for asking difficult questions about risk v. Data examples. 11. Using recordings for reflective practice a. The foundation of this book has been how recordings of multi-party interactions within mental health settings have been used to learn valuable lessons about good practice and developing practice. This chapter provides reader with an opportunity to use some of the techniques represented by the authors for their own clinical reflective practice. i. Clinical use of reflective practice ii. Pragmatics of recording mental health sessions iii. Using four column analysis for developing practice iv. Working with recordings in supervision and training v. Using discursive methodologies in clinical reflection (Reflective Interventionist Conversation Analysis; Video Reflexive Ethnography).
