Therapeutic work with children, young people and their families in private practice can be complex and challenging while differing significantly from therapeutic work in other contexts, such as education or CAMHS.
The practitioner in private practice is largely responsible for devising and operating their own policies in areas such as contracting, confidentiality, and child protection. They may find themselves working with risk in a different way to colleagues in other settings and, just as this might liberate the practitioner working in this context from some of the constraints of an agency setting it can leave them feeling anxious as they negotiate these tricky areas without official guidelines and statutory policy. The private practitioner working with this group will generally come into far more contact with the client’s parent(s) than they might in a different setting. Parents are usually the ones who make the initial referral, arrange to get the client to and from sessions, as well as the one who will pay the bill when it comes to it. Practitioners must ensure that as far as is possible the parents don’t intrude into the therapeutic space and this can be tricky. The idea for my book Counselling Children and Young People in Private Practice: A Practical Guide is to give some space to these issues so they can be carefully considered before going on to explore ways in which they might be managed effectively.
One of the key issues to consider in private practice with this group is payment of the fee. Parents often pay the therapist directly for their child’s counselling in private practice rather than indirectly via taxation as in school counselling or via CAMHS. Private therapy is expensive and parents may have worries regarding how long they will be required to pay or whether the therapy represents ‘value for money’. These concerns are understandable and often represent an economic reality for parents. It is important for practitioners to be realistic with them regarding how long therapy might take and whether they are recommending open-ended or brief, time-limited work as an appropriate intervention. Parents may also feel that as they are paying for the sessions they have some say in terms of the agenda for the work. They sometimes want to suggest things to their child to talk about in the session or ask what was discussed when they are on the car journey home afterwards. This of course can make maintaining confidentiality an area of difficulty in counselling with children and young people, and parents can sometimes struggle to balance their own need to protect and care for their child against the need for their child’s therapy to be private. The more open communication can take place between therapist and parents during the assessment and contracting phase and the clearer the boundaries established, hopefully the less that anxieties around this are likely to impinge upon the therapeutic work later on.
The presence of parents in whatever capacity in their child’s therapy certainly can make the child and adolescent therapist’s job more complicated but it can also be beneficial at times too. It is possible to assist parents in understanding how to help their child overcome their difficulties and be a part of the therapeutic work itself. Sometimes through their child having therapy, parents decide to enter therapy themselves. It can also help them to understand where their own emotional and psychological difficulties have had an impact on their parenting. Some are happy to take part in the work of understanding and untangling their own ‘family knots’ with the help of the therapist alongside them. Often it is the developmental stage the child has reached that will dictate to some extent the level of involvement the parents have in the therapy. Some adolescents have separated more fully than others and in these cases the practitioner is likely to have only minimal contact with the parents during the course of the therapy. In my experience, the therapist who works with children in private practice needs to operate as a gatekeeper of sorts; one who can protect the therapeutic space for their client but who can also allow in the elements from outside which may be beneficial for them, given that they will be living in their family environment, often for several years, once the therapy is over.
As well as issues around contracting and assessment, the book also covers other relevant topics such as setting-up in practice with this group, working with risk and referring on.
In the final part of the book I focus on the influence of advances in digital technology and social media on therapeutic work with children and young people. I explore the impact in three distinct categories; the impact on the young people themselves, growing up ‘digital natives’ (Prensky), the use of technology in the delivery of therapy itself, and the impact of the profession itself in terms of how therapists present themselves online and manage the distinctions between a private and professional life in cyber space.
Most of us who are in practice with children and young people will have experienced at least some of the myriad ways in which digital technology has had an impact on clients’ lives. In this part of the book I invite readers to explore some of the current research and ideas around this and consider what importance this might have for young people, particularly in terms of the development of their attachments and their attempts at separation. It may feel easier for some practitioners than others to engage with this aspect of their clients’ lives and hopefully the book goes some way to demystifying it for those who feel that this world is a little alien to them. It is also important for practitioners to consider how they will use the internet and social media themselves, if they wish to. Use of privacy settings and setting up separate personal and professional online identities are issues to be thought through carefully, particularly by those working with young people.
Overall, my hope is that this book will help practitioners already working in this field to give space and consideration to these important issues and to feel supported in the complex work they are undertaking. Also to encourage those who perhaps feel reticent about opening up private practice to this group to be able to do so with a sense of confidence and as being prepared to some extent for the ‘Sturm und Drang’ of working in this ultimately rewarding and important field.
Rebecca Kirkbride is a BACP Senior Accredited counsellor of adults, children, and young people. She originally undertook a training in psychodynamic psychotherapeutic counselling at the University of Sussex in 2000-02, since when she has worked as a counsellor and clinical supervisor in a number of settings, including education and private practice. She has developed and delivered training courses on attachment theory and professional development. Alongside this she maintains a private practice where she sees adults, children and young people, as well as offering clinical supervision to other practitioners working with these groups.
Her book Counselling Children and Young People in Private Practice: A Practical Guide is published this week by Karnac Books.