Ani De La Prida, BACP Registered Counsellor
I love my work with children and young people. I read a book called Dibs when I started training and I knew instantly that this was the work I wanted to do.
My training was person-centred and the course I did was flexible enough to allow me to work with adults, children, and young people. My practice has evolved and whilst I would still describe it as person-centred, I also now describe it as pluralistic.
Pluralism for me, firstly, is a perspective. I’m a little embarrassed to admit that I became evangelical about the person-centred approach, I believed that anything that wasn’t person-centred wasn’t effective. Thankfully I’ve moved on from that slightly arrogant position to a more respectful pluralistic view, supported by evidence which consistently shows that one type of therapy cannot suit everyone; and generally all bona fide therapies are roughly as effective as each other.
But pluralistic practice is also an approach in itself, or rather a collection of approaches which hold collaboration, attention to goals and outcomes, and adaption to each unique client at its heart. Uppermost for me in my practice is the therapeutic relationship, along with a deep trust in non-directivity; am I supporting a client’s actualising tendency or getting in the way of it? But there is a slight distinction from a person-centred approach in how actively I work with collaboration, aims, goals, and outcomes with children that I feel fits more comfortably under a pluralistic umbrella.
Currently I work in private practice, and so the first contact I have is with a parent. My preference is to have an initial ‘assessment’ session. I mean assessment in a non-diagnostic sense of finding out whether therapy is appropriate, if I feel I might be able to help, and importantly whether the child or young person wants to engage in therapy with me. Normally I meet the parent and young person together and we talk about what they feel the issues are, and then I see the young person alone. This is an opportunity to begin to distinguish, and work with a young person’s issues and aims.
Often, a dual contract develops. For example, a mum might want therapy to stop the young person being ‘angry and uncooperative’, whereas the young person might not care about that at all and might have entirely different aims. For example, they might be finding it hard to make friends, or they might be feeling unsure about their sexuality. I see working with this duality as creating a sort of bubble within a bubble, one that holds a client’s aims at its heart, within the context of an outer bubble that contains a parent’s aims.
Contracting with children might look different to contracting with adults, but it is just as important; probably more so in that it can help to address the inherent power imbalance that comes simply from not being an adult. Contracting with children needs a creative approach. For example, asking a child, ‘If I had a magic wand and could grant you three wishes, what would they be?’ can be a useful way to help a child verbalise aims and goals.
Young people’s aims can be very specific. If a child says, ‘I want my parents to stop arguing’, it gives me the opportunity to say that I don’t think therapy can stop parents arguing, and to explain ways that therapy could help. It might help to have a safe space to be sad, or angry, or to talk. Therapy might help them figure out how to talk about their feelings with their parents. Or, we could invite a parent into a session where I can talk about the arguing and advocate for the young person if they think that would help. Understanding a child’s aims or goals makes it easier to talk about preferences, or what a child wants therapy to look like. Do they want play or art? Talking or relaxing? Or possibly all of them. If they don’t have a clear aim, that’s ok too, we can agree to meet for a few sessions and just see how things go.
I often suggest we draw a chart together to represent where they are now. For example, if they score their sadness as a 9/10, we make a note. I also ask what they would like that number to be and we make a note of that too. I find children often ask to get their ‘chart’ out to see what has changed. It can be really helpful for children to have a visual representation of their progress towards their own goals, and it can help us talk about when they feel ready to end therapy.
A child may not have the choice of therapist or approach, but they are very capable of knowing what they want and what they need from therapy. Children as young as five have been able to tell me through actions or words that I’m too directive, or not directive enough. I find this can sometimes be a surprise for adults.
Jack [not his real name], aged nine, came to therapy feeling overwhelmed and sad. He was the eldest of four: his mum was an alcoholic, there was domestic violence at home, and Jack was often either intervening or being left looking after his mum and siblings. In therapy I talked about working non-directively, and Jack said, ‘but I want you to tell me what to do, I don’t want to choose’. This was a dilemma for me, how can I work non-directively with a client who wants direction?!
We contracted and we compromised. I would offer a choice of two activities, and he would choose. That way I felt I was still supporting his autonomy. One day I simply realised that Jack was tired of making decisions, of being in charge. He wanted to come to therapy to let go, he wanted an adult to be in charge. So, I let go, of my approach. I worked with what Jack wanted. When he arrived, I’d ask, ‘Am I in charge today or you?’ If he answered ‘you’ I would choose the activity. Sometimes he came and wanted to just lay down on the floor looking through the glass roof of the room. I lay down too and we watched the clouds together, sometimes talking sometimes not. Jack helped me to learn that a focus on working and adapting with each client as an individual is more important that adhering to an approach.
Children and young people might not be able to articulate in the same way that an adult can, but regardless of age they are as capable of knowing what they want and how they want to work. I love the spontaneity, creative responsiveness, and honesty of working with young people. I really value the learning they bring. I have also learned to lie down sometimes and just watch the clouds.