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Letter to the Editors

Janet Toye, 2013. Letter to the Editors. Reformulation, Winter, p.4.

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Ethical dilemma in working with children and adolescents

Among the several very thought provoking articles in the last issue of Reformulation there is one to which I think my experience is somewhat relevant. This was more than ten years ago when I was working as a couple therapist while using CAT. I have in mind three clients each of whom had a ‘difficult’ partner.

In two of those cases the client ‘s partner had declined or dropped out of work with both of them. The client in each case had decided she wanted therapy in order to stay with her partner and do whatever she could to improve the relationship, while also maintaining enough self-esteem to cope with the partner’s volatile and often abusive behaviour. Both people had given considerable thought to their situation and, for love of the partner, had decided they would stay come what may. In the third case the client had not suggested to his partner that she join him in couple therapy. He came with doubts about whether he wished to stay in the relationship with a strong tendency to think not. The work, which involved the usual CAT approach, moved apparently fairly steadily towards that conclusion but then, without my noticing any warning signs, the client suddenly dropped out and did not wish to return.

I found myself reflecting again on that case in the light of the article about children and young people with parents who are abusive towards them and very needy. While it is years since the case I describe and I have no access to the notes I think it likely that we did not explore adequately the client’s feelings about his partner’s neediness. Finding an exit strategy would have been helpful to him only if that had been done and a) he was completely sure that was what he wanted to do and b) he felt able to cope with the anxiety such an action would be likely to provoke. If that had proved impossible, the approach I had adopted with the other two clients would have been worth exploring.

I realise that attempts to explore fully a child’s feelings about both the possibility of staying and the possibility of leaving the parent, may or may not prove helpful. However, I think it worth considering as a potential way out of the dilemma of either reporting to the court and breaking the therapeutic bond, or of feeling like an accomplice in allowing a situation damaging to the child to continue.

It is indeed a very uncomfortable idea that a therapist should try to help a child adjust as well as possible to living with an abusive and needy parent. But is that not better than trying to help them leave, then finding that instead, the child is even more anxious about leaving the parent and more suspicious of other adults who may try to help?

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Full Reference

Janet Toye, 2013. Letter to the Editors. Reformulation, Winter, p.4.

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