I have just returned from a trip to Shanghai, where I taught in a four-day training program for mental health professionals caring for children. I was invited to participate by Dr. Joshua Sparrow, a colleague from Children’s Hospital Medical Center in Boston, and Director of Strategy, Planning, and Program Development of the Brazelton Center. The program was held at the Shanghai Mental Health Center and was conceived and organized by Dr. Wenhong Chen. It was a powerful experience for many reasons.
First of all, there was the excitement of being in Shanghai – a beautiful, vital, city of extreme contrasts. We walked through a warren of small wooden building where multigenerational families once lived in single rooms; now, the current residents live, side by side chic international shops. Over these old wooden communities, rise modern skyscrapers in glass and steel.
The lectures were fun to put together. Josh and I developed a curriculum to teach common childhood psychological disorders in the age group of 6-12-years years old organized around a developmental framework and using the Parent Consultation Model (PCM). For an explanation of the PCM, see below.
Second was the group of participants – psychiatrists, psychologists, guidance counselors, teachers, and others. Their commitment to learning was demonstrated by their decision to attend the intensive course – about ten hours per day, by their almost universal attendance, and by their thoughtful and generous questions and feedback after the lecture. After the training, one of the participants offered to begin the translation of this blog into Chinese, stating that Chinese caregivers could benefit from the information in the blog. I will provide a link to this translation sometime in the future.
The Parent Consultation Model (PCM)
Harrison AM., Herd the animals into the barn: a parent consultation model of child evaluation. The Psychoanalytic Study of Child, 2005; 60:128-157.
In our lectures we presented a number of cases of child psychotherapy. Each case was introduced with a description of the evaluation of the child and family using the Parent Consultation Model. Included in the clinical examples were children with autism spectrum disorder, disruptive behavioral disorder, anxiety disorder, trauma and loss, and depression. In each case we emphasized the parents’ concerns and questions as the focus of the consultation. Then, we illustrated the symptoms of the disorder by demonstrating the child’s difficulty accomplishing the developmental competencies appropriate to their ages. Finally, we showed how the child therapist worked with the parents, (caregivers) and the child ,to support the child’s attainment of these developmental achievements.
Brief Description of the Parent Consultation Model
The Parent Consultation Model emerged from my work in early development with infant research colleagues, as well as from my earlier work as a consultant to surgeons. I offer parents what I call a “parent consultation” in three sessions. The first session is with the parents alone to hear their concerns about their child and to get a history of the child and the family, but primarily to generate consultation questions for me as the parents’ consultant. The second meeting is with the whole family for a play (or talk with older children) session, designed to gather data to answer the parents’ questions. These are almost always pleasant meetings, which I direct and do not let anyone feel put on the spot. I videotape these family sessions since my infant work has taught me to value observational data, especially with videotape. The videotape is of course completely confidential. In between this meeting and the final meeting, I analyze the tape and come up with impressions that address the parents’ questions. Then in the final meeting, with the parents alone again, I get out the paper on which I have written their questions and address them one by one, giving them my impressions and illustrating what I think with short clips of videotape from the family meeting. Finally, I help the parents brainstorm what they want to do.
Adding Talk to the Family Session:
In those cases involving older children or adolescents, it is more appropriate to talk instead of play with toys. (Sometimes playing with puppets can be acceptable to older children in a family setting and can be very productive.) IChildren who are still young enough to express themselves in play (early school years), yet also highly verbal and can participate in a family play session that includes some talking.
The talking section of a family play session resembles a semi-structured interview. I ask each family member to tell me three things he or she likes about his or her family. Then I ask every family member to tell e three things they do not like, their complaints. Then I ask each parent to tell me a story from their own lives when they were the ages of each child in the family. Finally, I ask if the family has a pet. If the family does have a pet, I ask the story about the pet – how the family decided to bring a pet into the family, how the pet was chosen, and how the pet was named.
I do many of these consultations, so that I have known parents to choose a variety of options. One is to go home and try out some of the ideas we have come up with together. Another is to request an extended parent consultation with more observation of the video and more brainstorming about how to change family patterns. Another is to begin a psychotherapy with me or with someone else who takes their insurance or who lives closer to them, etc. The method gives the parents a lot of freedom to make choices.
What I have found over the many years I have been using this model is that it is rarely necessary to see the identified problem child alone in order to answer the parents’ questions, and in those cases in which it is important, that visit can follow naturally from new questions that arise in the third parent meeting. One advantage of this approach is that I don’t immediately begin to make an individual connection with a child who may not become my patient. Another is that I am free to make all sorts of important observations of the child in the context in which he or she lives – the way the child (and the family) express affect, communicate with language and in non-verbal ways, the way the family manages transitions and sets boundaries and maintains them, etc. These observations are in addition to the usual ones a child therapist makes about the content of the child’s speech or symbolic play.
In my teaching at a local hospital clinic in Cambridge, I have adapted the model to see a family in one morning. We do some of the important information gathering over the phone ahead of time – talking to the parents, pediatrician, and teacher, plus any other professionals involved with the family who have important information about the child. Then we see the family in a family play or talk session. This is videotaped. Finally, we speak to the parents alone to answer their questions and show them videotape illustrations of why we came to the conclusions we did in response to their questions. Finally, we help them brainstorm what they want to do. This tool has proven as effective in the clinic as in the private office.