Latest / Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D. / Working with More Than Just the Teen. Frontiers Friday #208 ⭕️

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Working with More Than Just the Teen. Frontiers Friday #208 ⭕️ · Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D.

• 0:00
  SPEAKER_00: Today's episode is dedicated to Austin Sparks and Ash Burton.
• 0:07
  SPEAKER_00: These are our readers of the Frontiers of Psychotherapist Development and they have
• 0:12
  SPEAKER_00: sent in questions related to working with more than just the teen.
• 0:19
  SPEAKER_00: So for those of you who are new to this, welcome to FPD, Frontiers of Psychotherapist Development.
• 0:25
  SPEAKER_00: My aim is to help psychotherapists go towards their bleeding edge of development.
• 0:30
  SPEAKER_00: And again,
• 0:31
  SPEAKER_00: if you are new here,
• 0:32
  SPEAKER_00: I recommend one good place for you to start is to go to our Substack page at
• 0:38
  SPEAKER_00: darylchown.substack.com and take a look at the 10 years of writing FPD.
• 0:49
  SPEAKER_00: FF, what we call Frontier's Friday, FF 189.
• 0:53
  SPEAKER_00: So if you go to darylchow.com, sorry, it's darylchow.substack.com.
• 0:59
  SPEAKER_00: So that's D-A-R-Y-L-C-H-O-W dot substack dot com.
• 1:07
  SPEAKER_00: And you can see sort of a compilation of over the last 10 years that I've been
• 1:12
  SPEAKER_00: doing this blog site,
• 1:15
  SPEAKER_00: which was previously out of Substack,
• 1:16
  SPEAKER_00: but now we're trying to have everything located in one place for easy access for readers.
• 1:23
  SPEAKER_00: So let me begin by reading the two questions or topic suggestions that came in from Austin and Ash.
• 1:32
  SPEAKER_00: So Austin says that he would like to know more about helping two or more at once in the therapy room.
• 1:39
  SPEAKER_00: And let me read out what Ash Burton has asked about.
• 1:44
  SPEAKER_00: She said,
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  SPEAKER_00: dear Daryl,
• 1:46
  SPEAKER_00: I'm a big fan of your work and have been going through a couple of different
• 1:49
  SPEAKER_00: courses of yours.
• 1:51
  SPEAKER_00: A question that I had in the structure and impact course is how would you structure
• 1:56
  SPEAKER_00: a teen therapy session with a 15 to 18 year old?
• 2:02
  SPEAKER_00: I have followed most of the same things,
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  SPEAKER_00: but I have noticed a tension between feeling the need to include parents in the
• 2:10
  SPEAKER_00: process and allowing the teen space.
• 2:15
  SPEAKER_00: I would love some guidance on this issue.
• 2:18
  SPEAKER_00: Bess, Ash
• 2:20
  SPEAKER_00: So this is a great question,
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  SPEAKER_00: combining together with what Austin was asking about helping more than two people
• 2:26
  SPEAKER_00: at once in a therapy room.
• 2:28
  SPEAKER_00: So I'm going to do my best to reply to this.
• 2:31
  SPEAKER_00: And I would just give some guiding principles that organizes the way I work, how it orientates me.
• 2:39
  SPEAKER_00: And then I would go through some of the strategies that I take more specifically about what exactly
• 2:45
  SPEAKER_00: And how do I go about navigating that within a therapy room of more than one person,
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  SPEAKER_00: especially working with a youth?
• 2:54
  SPEAKER_00: So first up, let me just make some general comments.
• 2:58
  SPEAKER_00: And this is what I think.
• 3:01
  SPEAKER_00: Working with more than one person,
• 3:03
  SPEAKER_00: it's often more impactful than I think,
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  SPEAKER_00: than working with a single individual in the room.
• 3:09
  SPEAKER_00: It's usually easier to manage, of course, when you're just working with one person.
• 3:13
  SPEAKER_00: But let's also bear in mind that from our client's perspective,
• 3:17
  SPEAKER_00: especially the adolescent,
• 3:19
  SPEAKER_00: they spend more time with their family and friends than with you.
• 3:23
  SPEAKER_00: And also we don't want a scenario where the team's issues are completely outsourced
• 3:30
  SPEAKER_00: to a professional and in turn rendering the parents or the caregivers useless.
• 3:37
  SPEAKER_00: What we want to do is to be able to invite them into this collaborative space of
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  SPEAKER_00: speaking some of the stuff that don't normally get talked about and to be able to
• 3:46
  SPEAKER_00: bring them into conversation.
• 3:49
  SPEAKER_00: And also,
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  SPEAKER_00: we don't want to become a disabling profession,
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  SPEAKER_00: which was a book title by Ivan Ilinch quite a while ago.
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  SPEAKER_00: Disabling profession is one that attempts to help,
• 4:01
  SPEAKER_00: but in the attempts to help actually disables people from their way of living and a
• 4:08
  SPEAKER_00: way that they can live in a harmonious way within their natural setting.
• 4:13
  SPEAKER_00: And also we must appreciate the reality that each person exists in a system called a family.
• 4:21
  SPEAKER_00: Now, I've worked with those who are disconnected from their family systems who are in state care.
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  SPEAKER_00: And this is a source of profound pain and psychic ache for the child and for the
• 4:34
  SPEAKER_00: youth to not have that sort of connection with people in their bloodlines or people
• 4:40
  SPEAKER_00: who are vulnerable.
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  SPEAKER_00: the ones that are foundational for them since they were a child.
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  SPEAKER_00: So it sounds rather obvious to say it,
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  SPEAKER_00: but when we know that when there's a lack of that sort of bedrock of a family,
• 4:53
  SPEAKER_00: it's really challenging and difficult for the child.
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  SPEAKER_00: Also, in conjoined sessions, it's often impactful for the parents and caregivers.
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  SPEAKER_00: And you might also get response from youths who shrug and say,
• 5:08
  SPEAKER_00: eh,
• 5:09
  SPEAKER_00: you know,
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  SPEAKER_00: no big deal about those things.
• 5:11
  SPEAKER_00: So sometimes there may be some kind of resistance, but you'd be surprised.
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  SPEAKER_00: Some youths are actually very open to have the parents involved as well.
• 5:19
  SPEAKER_00: So in short, don't be too quick to discount that.
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  SPEAKER_00: And as the writer Mary Carr point out, any family of more than one person is dysfunctional.
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  SPEAKER_00: So,
• 5:33
  SPEAKER_00: you know,
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  SPEAKER_00: it's always good to be able to address some of the things that are the
• 5:37
  SPEAKER_00: interactional patterns that play out where the patterns may become a dysfunctional loop.
• 5:43
  SPEAKER_00: And we might want to find a way to address that.
• 5:45
  SPEAKER_00: So before we get into the guiding principles and the strategies,
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  SPEAKER_00: I also want to say that part of my own foundational training is from a systemic
• 5:53
  SPEAKER_00: family therapy perspective.
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  SPEAKER_00: A lot of this is informed by my learnings from the greats like Sevador Mnuchin,
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  SPEAKER_00: the people,
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  SPEAKER_00: the founders of like the Structural Family Therapy,
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  SPEAKER_00: Virginia Satya,
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  SPEAKER_00: Kyle Whitaker,
• 6:06
  SPEAKER_00: and so on.
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  SPEAKER_00: And also directly speaking from my own
• 6:10
  SPEAKER_00: supervisor mentor and friend Juliana who has been a wellspring of inspiration and
• 6:17
  SPEAKER_00: life-givingness for me for a long time.
• 6:20
  SPEAKER_00: So a lot of what I'm going to talk about is informed by that background.
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  SPEAKER_00: So let's begin with those guiding principles that I've mentioned, and there's going to be five of them.
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  SPEAKER_00: And why start with guiding principles?
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  SPEAKER_00: Because if you know the guiding principles,
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  SPEAKER_00: methods abound from that,
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  SPEAKER_00: depending on your style,
• 6:42
  SPEAKER_00: depending on your worldview,
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  SPEAKER_00: and depending on the needs of your clients.
• 6:46
  SPEAKER_00: So to have these guiding principles as a bedrock could be helpful for you in doing
• 6:52
  SPEAKER_00: the ways that you would approach therapy.
• 6:54
  SPEAKER_00: So the first one is give voice to the voiceless.
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  SPEAKER_00: the younger the client my rule of thumb is the younger the client the more i want
• 7:05
  SPEAKER_00: the involvement of caregivers so now like with ash 15 and 18 years old in terms of
• 7:12
  SPEAKER_00: chronological age you might think that most of most youths would want their own
• 7:18
  SPEAKER_00: autonomy and own space and that could be true but there are also youths at that age
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  SPEAKER_00: may want more involvement simply because of the lack of involvement
• 7:29
  SPEAKER_00: of their parents in their life.
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  SPEAKER_00: And you'd be surprised that when asked, sometimes they are actually more willing than we think.
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  SPEAKER_00: Now, give voice to the voiceless.
• 7:39
  SPEAKER_00: The balance is not the aim when I say that guiding principle.
• 7:44
  SPEAKER_00: Balance is not the aim.
• 7:46
  SPEAKER_00: Proportion is.
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  SPEAKER_00: So the thing I want to skew towards is when I listen to the youth with the parents,
• 7:55
  SPEAKER_00: I want to hear who has got less voice within that system.
• 8:01
  SPEAKER_00: And then I want to tilt towards more of that to create space for that voice,
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  SPEAKER_00: not only to be expressed,
• 8:10
  SPEAKER_00: but also to be heard,
• 8:12
  SPEAKER_00: listened and attended to in that therapeutic environment.
• 8:17
  SPEAKER_00: If it's hard to give voice in the presence of others,
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  SPEAKER_00: I mean,
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  SPEAKER_00: you can for sure start with individual sessions first,
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  SPEAKER_00: but then being flexible to say that maybe there are times where you may allow the
• 8:30
  SPEAKER_00: conjoint sessions with the caregivers and then may interweave back with individual
• 8:35
  SPEAKER_00: sessions as well.
• 8:37
  SPEAKER_00: But we have to ask,
• 8:40
  SPEAKER_00: if that is difficult,
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  SPEAKER_00: why is it difficult for that particular youth to express themselves in the presence
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  SPEAKER_00: of a particular caregiver?
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  SPEAKER_00: How has their parents previously responded to them when they have tried to speak?
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  SPEAKER_00: Or is there no room for that sort of quieter voice to speak out?
• 9:02
  SPEAKER_00: And notice how affect, how the emotions change in the presence of different parents as well.
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  SPEAKER_00: So for example,
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  SPEAKER_00: you may notice that a youth,
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  SPEAKER_00: a guy with his father,
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  SPEAKER_00: he's able to talk quite casually,
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  SPEAKER_00: but then as soon as in the presence of the mom,
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  SPEAKER_00: you could almost viscerally feel the temperature in the room change,
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  SPEAKER_00: like the youth starts to clam up.
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  SPEAKER_00: So notice that we're not trying to play any kind of finger pointing blame game,
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  SPEAKER_00: but what we are really trying to do is to be sensitized to the interactional system,
• 9:39
  SPEAKER_00: the space between them,
• 9:40
  SPEAKER_00: if you like.
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  SPEAKER_00: So in conjoined sessions, you could ask, who is the more outspoken one?
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  SPEAKER_00: Who is the more subjugated one?
• 9:50
  SPEAKER_00: And then your role is to facilitate that,
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  SPEAKER_00: is to subvert the norm,
• 9:56
  SPEAKER_00: to make what Gregory Bateson used to say,
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  SPEAKER_00: a difference that makes a difference,
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  SPEAKER_00: where then you're allowing the one with a smaller voice,
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  SPEAKER_00: the quieter voice to be voiced.
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  SPEAKER_00: The second guiding principle, listening to each other into speech, speaking the unspoken.
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  SPEAKER_00: And at specific times, allow parents just to listen even without worrying about responding.
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  SPEAKER_00: So meaning to say that sometimes even just having the parents be there
• 10:31
  SPEAKER_00: And they don't have to act,
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  SPEAKER_00: you don't have to like proportion the conversation where,
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  SPEAKER_00: you know,
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  SPEAKER_00: okay,
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  SPEAKER_00: I've done like 15 minutes with the youth now,
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  SPEAKER_00: I got to go another 15 minutes for the parent.
• 10:42
  SPEAKER_00: It doesn't have to be about that, right?
• 10:45
  SPEAKER_00: You can actually allow the parents, you can even prime them to say, you don't have to worry about...
• 10:51
  SPEAKER_00: giving your point of view at this point.
• 10:54
  SPEAKER_00: And all I need you to do is to be free of responding and just absorb, just absorb what's being said.
• 11:01
  SPEAKER_00: And then later,
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  SPEAKER_00: near the last part of the session,
• 11:05
  SPEAKER_00: you could deconstruct and debrief with the parents and then allow the youth to then
• 11:12
  SPEAKER_00: listen to their own reflections from the parents' point of view.
• 11:15
  SPEAKER_00: We're going to talk a bit more about some strategies relating to this on listening
• 11:20
  SPEAKER_00: to each other into speech.
• 11:22
  SPEAKER_00: And the third guiding principle, being a witness to each other.
• 11:27
  SPEAKER_00: And, you know, I'm playing with that word about witness and witness.
• 11:32
  SPEAKER_00: Witness is something that we tend to associate with legal metaphor, like you're a witness at the stand.
• 11:39
  SPEAKER_00: To be a witness is to be with somebody at that point and to be able to witness,
• 11:46
  SPEAKER_00: to be able to see,
• 11:47
  SPEAKER_00: hear and absorb all of what's going on.
• 11:50
  SPEAKER_00: And in this guiding principle is impacting not just the relationship between
• 11:54
  SPEAKER_00: therapist and client,
• 11:55
  SPEAKER_00: but client and their family members as well.
• 11:59
  SPEAKER_00: After all, they spend more time with their families than with you, as we mentioned at the outset.
• 12:04
  SPEAKER_00: And Thich Nhat Ha, the late Buddhist monk used to say this in his book, How to Love.
• 12:11
  SPEAKER_00: Understanding is love's other name.
• 12:15
  SPEAKER_00: If you don't understand, you can't love.
• 12:19
  SPEAKER_00: So to be a witness is means to be with somebody and to hear like the other guiding principle,
• 12:27
  SPEAKER_00: the unspokens that is brought into speech.
• 12:30
  SPEAKER_00: And your attempt of being a witness is to understand.
• 12:36
  SPEAKER_00: That's like the doorway to love,
• 12:40
  SPEAKER_00: a doorway towards the person's inner life,
• 12:44
  SPEAKER_00: the other person's inner life.
• 12:47
  SPEAKER_00: Number four, the fourth guiding principle is we are a community of internalized others.
• 12:56
  SPEAKER_00: What do I mean by this?
• 12:58
  SPEAKER_00: These days, IFS or internal family system seems to be quite in vogue.
• 13:03
  SPEAKER_00: about speaking in parts.
• 13:05
  SPEAKER_00: And this is somewhat related to that.
• 13:07
  SPEAKER_00: But this term,
• 13:09
  SPEAKER_00: internalized others,
• 13:11
  SPEAKER_00: is borrowed from Carl Torm,
• 13:14
  SPEAKER_00: a Canadian psychiatrist and family therapist,
• 13:17
  SPEAKER_00: whom I have great appreciation for his work and his writings.
• 13:23
  SPEAKER_00: And he talks about how each of us, we have a community of people that we internalize within us.
• 13:29
  SPEAKER_00: They become parts of our lives.
• 13:31
  SPEAKER_00: So when I think about this, part of my mother is within me.
• 13:36
  SPEAKER_00: Part of my father is also internalized within me.
• 13:41
  SPEAKER_00: And parts of people who are significant in my life from mentors to loved ones,
• 13:47
  SPEAKER_00: to family members as well.
• 13:48
  SPEAKER_00: All those things, they are part of us.
• 13:51
  SPEAKER_00: And we're going to talk a bit about how this plays out from a strategic standpoint.
• 13:55
  SPEAKER_00: But just to bear this in mind,
• 13:56
  SPEAKER_00: that we are a community of internalized other people that shape our personality,
• 14:02
  SPEAKER_00: shape our inner and outer life,
• 14:04
  SPEAKER_00: and shape our worldview as well.
• 14:07
  SPEAKER_00: And the fifth and final guiding principle is when we love,
• 14:13
  SPEAKER_00: We love poorly.
• 14:15
  SPEAKER_00: That's just a fact that when we are trying to love someone, we end up loving poorly.
• 14:22
  SPEAKER_00: Henry Norman,
• 14:23
  SPEAKER_00: one of the writers that I really admire,
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  SPEAKER_00: he said this,
• 14:27
  SPEAKER_00: he said that forgiveness is the name of love practiced among people who love poorly.
• 14:34
  SPEAKER_00: The hard truth is that all people love poorly.
• 14:39
  SPEAKER_00: So this is not just because we are not succeeding.
• 14:43
  SPEAKER_00: This is just part of our humanity that our attempts to love is that we love poorly,
• 14:49
  SPEAKER_00: which is why I think the other topic related to our lives or in therapy actually in general,
• 14:57
  SPEAKER_00: we do need to understand about forgiveness,
• 15:01
  SPEAKER_00: what that really means and where that plays out in our relational life.
• 15:07
  SPEAKER_00: So with that, we're going to go into the strategies.
• 15:11
  SPEAKER_00: But as a quick sum up,
• 15:13
  SPEAKER_00: the guiding principles that we have so far are,
• 15:16
  SPEAKER_00: number one,
• 15:17
  SPEAKER_00: give voice to the voiceless.
• 15:19
  SPEAKER_00: Two, listening to each other into speech.
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  SPEAKER_00: Three, being a witness to each other.
• 15:27
  SPEAKER_00: Four, we are a community of internalized others.
• 15:30
  SPEAKER_00: And five, when we love, we love poorly.
• 15:35
  SPEAKER_00: So let's go into the strategies and strategies about like the more concrete things
• 15:41
  SPEAKER_00: of how you manifest those guiding principles into being.
• 15:45
  SPEAKER_00: Now, they may not be like a one for one sort of a tit for tat of that.
• 15:49
  SPEAKER_00: So I've got about six of them.
• 15:51
  SPEAKER_00: So they don't really nicely fit into that.
• 15:53
  SPEAKER_00: But you could see you could start to play with this idea of how you can work with
• 15:59
  SPEAKER_00: more than one person in the room,
• 16:01
  SPEAKER_00: especially when working with a youth and a caregiver.
• 16:06
  SPEAKER_00: The first strategy is to create structure.
• 16:10
  SPEAKER_00: Why?
• 16:11
  SPEAKER_00: Because things would often get messy.
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  SPEAKER_00: Structure is not being rigid.
• 16:16
  SPEAKER_00: Structure are just meant to be having scaffolds.
• 16:20
  SPEAKER_00: And like when you're building a building, scaffolds are there, but after that you tear it down, right?
• 16:25
  SPEAKER_00: So you don't want to get hung up about the structure.
• 16:29
  SPEAKER_00: But the structures are there to help you build, help you to scaffold.
• 16:33
  SPEAKER_00: So one way to think about what is structure is this.
• 16:37
  SPEAKER_00: Here's the thought experiment that you can have.
• 16:39
  SPEAKER_00: At any given point in time of the conversation with the people in the room,
• 16:47
  SPEAKER_00: if somebody comes in and asks you what exactly you're doing,
• 16:52
  SPEAKER_00: then you could explain the following three things.
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  SPEAKER_00: And they are, where are you?
• 17:01
  SPEAKER_00: Where are you going?
• 17:03
  SPEAKER_00: Why?
• 17:04
  SPEAKER_00: Just these three things.
• 17:07
  SPEAKER_00: Where are you?
• 17:08
  SPEAKER_00: Where are you going?
• 17:09
  SPEAKER_00: And why?
• 17:11
  SPEAKER_00: To me, when you know those three answers, you are basically creating those structures, those scaffolds.
• 17:20
  SPEAKER_00: But more importantly, would your client also reply the same answers to those three independently?
• 17:29
  SPEAKER_00: Because that's important that we are clear about where are we,
• 17:33
  SPEAKER_00: what kind of situation do we have the same appreciation and even the same
• 17:37
  SPEAKER_00: metaphorical use in our language to describe where are we,
• 17:41
  SPEAKER_00: like the crossroads,
• 17:42
  SPEAKER_00: or we're at a tipping point,
• 17:44
  SPEAKER_00: or we're really at the brink,
• 17:45
  SPEAKER_00: or there's some sort of like,
• 17:47
  SPEAKER_00: um,
• 17:48
  SPEAKER_00: a real transition in their life right now,
• 17:50
  SPEAKER_00: if we're agreeing about that or they're stuck,
• 17:53
  SPEAKER_00: let's say,
• 17:54
  SPEAKER_00: and then where are we going?
• 17:56
  SPEAKER_00: So this may speak about direction, goals, aims, etc.
• 18:01
  SPEAKER_00: about that.
• 18:02
  SPEAKER_00: But the third one's important, the why.
• 18:05
  SPEAKER_00: The reason for doing all of that.
• 18:08
  SPEAKER_00: If we have agreement on all these three, we're in a good way.
• 18:12
  SPEAKER_00: So structure is really critical when working with an individual,
• 18:17
  SPEAKER_00: but structure is even more important when working with more than one person in the
• 18:21
  SPEAKER_00: room so that we can spell out why are we doing what we're doing,
• 18:26
  SPEAKER_00: where are we,
• 18:27
  SPEAKER_00: and where we're trying to go with having the parents involved in this situation.
• 18:32
  SPEAKER_00: So all these things starts to become a little bit clear and it's rational.
• 18:36
  SPEAKER_00: And I sort of alluded the second one early on.
• 18:39
  SPEAKER_00: The second strategy is to simply mix it up.
• 18:42
  SPEAKER_00: That there's some sessions that you can have conjoined and some sessions you can have individual.
• 18:47
  SPEAKER_00: I tend to not have the parents only.
• 18:51
  SPEAKER_00: The reason for that is because it creates a kind of wondering,
• 18:56
  SPEAKER_00: unspoken wondering about what do you speak about?
• 18:59
  SPEAKER_00: Was there some things that...
• 19:00
  SPEAKER_00: They said that you didn't tell me, that you might think.
• 19:03
  SPEAKER_00: But also,
• 19:04
  SPEAKER_00: you don't want the situation that when then the parents would say something and say,
• 19:08
  SPEAKER_00: please don't tell my child that I said this.
• 19:11
  SPEAKER_00: So it gets really tricky, especially the older ones in the 15 to 18 years.
• 19:17
  SPEAKER_00: But you can have individual sessions and then you can have joint sessions as well.
• 19:21
  SPEAKER_00: I find that really useful and it can help you also see different dynamics between
• 19:26
  SPEAKER_00: what's happening when they speak with you individually.
• 19:28
  SPEAKER_00: Are they more free that way?
• 19:31
  SPEAKER_00: And then with their mom or their dad, does it change depending on is it the mom or dad?
• 19:38
  SPEAKER_00: And then you could then get a sense of what kind of dynamic there are.
• 19:42
  SPEAKER_00: And then you could also plan about what needs to be addressed within certain
• 19:47
  SPEAKER_00: dynamics of kind of type of interactional pattern that plays out.
• 19:52
  SPEAKER_00: The third strategy is allowing contradictory perspectives.
• 19:58
  SPEAKER_00: So a quick way to do this,
• 20:00
  SPEAKER_00: and for those of you who are familiar with our work here in Frontiers,
• 20:04
  SPEAKER_00: is that we measure outcomes of each client.
• 20:09
  SPEAKER_00: So we use a measure such as the outcome rating scale or the ROS or the rating scale.
• 20:15
  SPEAKER_00: outcome scale or you could use the core 10 or if you're using the all q45 it
• 20:19
  SPEAKER_00: doesn't matter but these all fall under the umbrella of global well-being i tend to
• 20:26
  SPEAKER_00: skew towards measuring that and personalized goals and less about symptoms specific
• 20:32
  SPEAKER_00: because to predetermine certain symptom specific measure narrows the focus a little
• 20:38
  SPEAKER_00: bit too quickly especially from the get-go
• 20:40
  SPEAKER_00: So symptom-specific measures are like the back to depression inventory or the DAS,
• 20:46
  SPEAKER_00: which is something to measure about the depression,
• 20:48
  SPEAKER_00: anxiety,
• 20:48
  SPEAKER_00: and stress.
• 20:49
  SPEAKER_00: Though there's a moderate correlation with well-being,
• 20:52
  SPEAKER_00: but most well-being measures tend to tap on three things,
• 20:56
  SPEAKER_00: which is
• 20:57
  SPEAKER_00: how a person feels on the inside, their relationship and what they are doing.
• 21:03
  SPEAKER_00: So they tend to fall into what I call well-being, well-belonging and well-doing sort of dimensions.
• 21:11
  SPEAKER_00: I find that much more important actually,
• 21:13
  SPEAKER_00: because if you could tap into that,
• 21:15
  SPEAKER_00: then you are getting a more balanced and more specific picture about how they feel
• 21:22
  SPEAKER_00: on the inside,
• 21:23
  SPEAKER_00: what they're doing in their life and their relationships.
• 21:26
  SPEAKER_00: But the contrary perspective when you get something from this measure is you can do the following.
• 21:31
  SPEAKER_00: You get the client to rate how they're feeling.
• 21:34
  SPEAKER_00: So let's say with the ORS,
• 21:36
  SPEAKER_00: they rate about how they are in the last week,
• 21:38
  SPEAKER_00: including the day that you're meeting you.
• 21:41
  SPEAKER_00: And you can get the caregivers to also rate their view of the client.
• 21:49
  SPEAKER_00: So they are rating from an other person's perspective.
• 21:53
  SPEAKER_00: So to do that gets very interesting conversations sprouting from that.
• 22:00
  SPEAKER_00: And if you're mixing that up, you could even sometimes rate how you think.
• 22:06
  SPEAKER_00: So each individual rate their own well-being first and foremost.
• 22:10
  SPEAKER_00: So if you're doing more family oriented rather than individual therapy type of work.
• 22:15
  SPEAKER_00: You can get the parents to rate how they are doing.
• 22:19
  SPEAKER_00: And then the client, the younger child can rate how they are doing as well.
• 22:24
  SPEAKER_00: And then you could say,
• 22:25
  SPEAKER_00: okay,
• 22:26
  SPEAKER_00: now I would like you to rate how you think your mom rated without seeing their own
• 22:32
  SPEAKER_00: ratings first.
• 22:33
  SPEAKER_00: And then the parents can rate how the child is doing.
• 22:36
  SPEAKER_00: Again, that sprouts all kinds of interesting conversations.
• 22:40
  SPEAKER_00: The key is that you allow it to be used not as an assessment tool, but as a conversational tool.
• 22:51
  SPEAKER_00: Lots of wonderful questions would come from there, especially when there's difference.
• 22:56
  SPEAKER_00: So you might get the parents who rated the child to be really low and in the clinical distress range,
• 23:04
  SPEAKER_00: And then the child may rate, no, everything's going fine, except for the school one.
• 23:10
  SPEAKER_00: So that creates interesting questions, even from the parents themselves.
• 23:14
  SPEAKER_00: And the child might also ask, oh, how come you see that way?
• 23:17
  SPEAKER_00: That's a good springboard to start off.
• 23:21
  SPEAKER_00: At other times, the opposite can occur as well.
• 23:25
  SPEAKER_00: So I remember a case from a while back where I got the father to do the outcome
• 23:33
  SPEAKER_00: rating scale from his perception of the son and the son did of his own as well.
• 23:39
  SPEAKER_00: What was interesting that came out of that was
• 23:41
  SPEAKER_00: was that the father scored quite a bit higher in terms of how he perceives his
• 23:46
  SPEAKER_00: son's well-being to be compared to the son's.
• 23:49
  SPEAKER_00: And the son's score was significantly lower.
• 23:53
  SPEAKER_00: And this sparked sort of curiosity from the father's point of view,
• 23:58
  SPEAKER_00: because he thought that,
• 23:59
  SPEAKER_00: yes,
• 24:00
  SPEAKER_00: there were some difficulties,
• 24:01
  SPEAKER_00: but didn't realize that the struggle...
• 24:04
  SPEAKER_00: what the child was going through was so much more difficult than he thought,
• 24:08
  SPEAKER_00: especially from not only the social domain,
• 24:11
  SPEAKER_00: but also how he was feeling on the inside.
• 24:14
  SPEAKER_00: And that sort of promotes,
• 24:16
  SPEAKER_00: that catalyzes an empathic wish to understand a little bit more from the father's
• 24:22
  SPEAKER_00: point of view.
• 24:23
  SPEAKER_00: And then when the child feels more understood by the father,
• 24:27
  SPEAKER_00: that too has a profound impact on the family system.
• 24:32
  SPEAKER_00: So allow contradictory perspectives.
• 24:36
  SPEAKER_00: Number four, express the unspokens.
• 24:41
  SPEAKER_00: One of the things I like to make clear,
• 24:43
  SPEAKER_00: whether an individual or working with more than one,
• 24:48
  SPEAKER_00: maybe the caregivers involved,
• 24:49
  SPEAKER_00: or maybe even couples,
• 24:51
  SPEAKER_00: is to make it clear that this is a space to allow for them to speak the unspokens.
• 24:59
  SPEAKER_00: So to make this sort of overt,
• 25:02
  SPEAKER_00: make this clear from the beginning,
• 25:04
  SPEAKER_00: lays the foundation that we get to speak about the stuff that are often not spoken about,
• 25:10
  SPEAKER_00: maybe even things that we feel ashamed about,
• 25:13
  SPEAKER_00: things that we feel that we may have some difficulty about,
• 25:16
  SPEAKER_00: and that we're not going to rush in and sort of dominate through our way and push
• 25:23
  SPEAKER_00: through all the Q&A of assessments.
• 25:25
  SPEAKER_00: Parker Palmer had a way of describing this as if when we're approaching a wild
• 25:30
  SPEAKER_00: animal in the woods,
• 25:31
  SPEAKER_00: we don't rush in and charge to try and see it.
• 25:35
  SPEAKER_00: But instead,
• 25:36
  SPEAKER_00: we take gentle steps,
• 25:38
  SPEAKER_00: allowing to approach very slowly,
• 25:41
  SPEAKER_00: but also for the wild animal to see us and for both sides to feel disarmed,
• 25:47
  SPEAKER_00: to feel comfortable,
• 25:48
  SPEAKER_00: to feel safe,
• 25:49
  SPEAKER_00: to speak those things that we don't really speak so much about.
• 25:53
  SPEAKER_00: So it could be about the past.
• 25:55
  SPEAKER_00: It could be about things that were very difficult.
• 25:57
  SPEAKER_00: It could be about traumatic stuff, all the above.
• 26:01
  SPEAKER_00: So if you like,
• 26:02
  SPEAKER_00: you could look at one of the articles I wrote called listening to speech,
• 26:06
  SPEAKER_00: and I break down three components of how you could listen,
• 26:09
  SPEAKER_00: how you could help each other listen and how as therapists we could listen as well.
• 26:14
  SPEAKER_00: What I call listening to what we will say, won't say, and can't say.
• 26:19
  SPEAKER_00: So more on that in this particular article.
• 26:24
  SPEAKER_00: One variant about this of expressing the unspokens,
• 26:27
  SPEAKER_00: one way we can sort of help to open up some doorways into this conversation is to
• 26:34
  SPEAKER_00: ask the following question.
• 26:37
  SPEAKER_00: What is it like to be you?
• 26:39
  SPEAKER_00: And this could be asked to each family member.
• 26:42
  SPEAKER_00: What is it like for you?
• 26:44
  SPEAKER_00: What is it like for you when you were a child?
• 26:47
  SPEAKER_00: What was it like for you when you first left home?
• 26:50
  SPEAKER_00: What was it like for you when you had that relationship difficulty?
• 26:54
  SPEAKER_00: So that what is it like to be you, it's a reach to understand, a reach to want to know.
• 27:02
  SPEAKER_00: And sometimes you could help each other within the dialogue to say,
• 27:08
  SPEAKER_00: tell me the story about so and so and so and fill in the blank.
• 27:14
  SPEAKER_00: And I like to do this with parents in the room.
• 27:17
  SPEAKER_00: And the focus could be quite a lot about the child.
• 27:19
  SPEAKER_00: Sometimes I like to de-focus on that and ask the mom,
• 27:25
  SPEAKER_00: let's say,
• 27:26
  SPEAKER_00: and ask her to tell us the story about her childhood.
• 27:29
  SPEAKER_00: So I would say,
• 27:30
  SPEAKER_00: tell me the story about you and your difficulties with your father when you were
• 27:35
  SPEAKER_00: growing up.
• 27:35
  SPEAKER_00: Because the parent might have hinted some things about that.
• 27:38
  SPEAKER_00: And then watch carefully on not just what the parents say,
• 27:43
  SPEAKER_00: but just watch the reaction of the youth,
• 27:47
  SPEAKER_00: whether or not they know these stories,
• 27:49
  SPEAKER_00: whether or not these stories were unspoken.
• 27:53
  SPEAKER_00: And some of the details could have been talked about,
• 27:56
  SPEAKER_00: but if you could create this sort of space,
• 27:58
  SPEAKER_00: they could talk at a greater depth on certain things,
• 28:02
  SPEAKER_00: on their inexperience.
• 28:03
  SPEAKER_00: And you could check and ask the youth, did you know about that?
• 28:08
  SPEAKER_00: Did you know that your father had difficulties with his parents?
• 28:12
  SPEAKER_00: Did you know that your mom ran away when she was about your age?
• 28:16
  SPEAKER_00: Did you know that she struggled to find her place in this world and so on and so on?
• 28:21
  SPEAKER_00: So this expands the narrative.
• 28:25
  SPEAKER_00: And this is important.
• 28:26
  SPEAKER_00: Why?
• 28:27
  SPEAKER_00: Because all of us need a coherent narrative of ourself and of the place,
• 28:32
  SPEAKER_00: the people that we grew up from and with.
• 28:37
  SPEAKER_00: And number five, the fifth strategy that I like to think about is the following question.
• 28:44
  SPEAKER_00: How healthy is the family?
• 28:47
  SPEAKER_00: This idea typically stems from an organizational psychology type of perspective to
• 28:53
  SPEAKER_00: think about how healthy is the team within the workspace.
• 28:57
  SPEAKER_00: But you could think about families as an organic team, right?
• 29:01
  SPEAKER_00: And
• 29:02
  SPEAKER_00: Ask each person to think about that question from your perspective.
• 29:07
  SPEAKER_00: How healthy is the family?
• 29:10
  SPEAKER_00: Not about the individuals, but as the system as a whole, a unit within the family as one.
• 29:16
  SPEAKER_00: So you could simply ask that question and then ask each person to rate 0 to 10,
• 29:23
  SPEAKER_00: do it independently,
• 29:24
  SPEAKER_00: write it down,
• 29:25
  SPEAKER_00: and then verbalize that,
• 29:27
  SPEAKER_00: right?
• 29:27
  SPEAKER_00: Because...
• 29:29
  SPEAKER_00: A healthy team, a healthy unit has got three fundamental components.
• 29:35
  SPEAKER_00: It's about contribution, it's about appreciation, and it's about development.
• 29:44
  SPEAKER_00: Contribution is meaning how much you feel like you play a part,
• 29:48
  SPEAKER_00: that you contribute to the role of the bigger picture and the family.
• 29:52
  SPEAKER_00: Appreciation is whether you feel appreciated about who you are,
• 29:56
  SPEAKER_00: what you do,
• 29:57
  SPEAKER_00: what you bring to the table and your presence within the team.
• 30:00
  SPEAKER_00: Are you appreciated for being there?
• 30:03
  SPEAKER_00: And then development, do you feel like you are growing?
• 30:06
  SPEAKER_00: Do you feel like the direction you are growing, the person that you're becoming is also valued?
• 30:11
  SPEAKER_00: within that, right?
• 30:12
  SPEAKER_00: So there's three components critical for a healthy team.
• 30:17
  SPEAKER_00: Treat the team like a living organism.
• 30:22
  SPEAKER_00: One time I asked a mother and daughter this question about how healthy they think
• 30:28
  SPEAKER_00: each other,
• 30:29
  SPEAKER_00: not each other,
• 30:30
  SPEAKER_00: but as the unit of the family,
• 30:31
  SPEAKER_00: how healthy the family was.
• 30:33
  SPEAKER_00: They wrote it down very quickly on zero to 10, 10 being the highs.
• 30:37
  SPEAKER_00: And both of them independently wrote down six.
• 30:42
  SPEAKER_00: And both were delighted that they scored at the same number.
• 30:46
  SPEAKER_00: But what's more interesting is the explanations behind that.
• 30:50
  SPEAKER_00: And then both of them talked about...
• 30:53
  SPEAKER_00: Actually not about both of them,
• 30:54
  SPEAKER_00: they talked about this,
• 30:55
  SPEAKER_00: one of the other siblings,
• 30:57
  SPEAKER_00: the son,
• 30:58
  SPEAKER_00: the brother,
• 30:59
  SPEAKER_00: about how the brother is getting on so much better and the fact that the brother is
• 31:03
  SPEAKER_00: going on so much better because he had a very difficult time with addictions issue
• 31:08
  SPEAKER_00: and that had such profound ripple on effect.
• 31:11
  SPEAKER_00: And this led to further discussions about subunits within the family.
• 31:16
  SPEAKER_00: So about the relationship between the father and son,
• 31:19
  SPEAKER_00: which is a bit strange because of some of the tumultuous time they went through.
• 31:23
  SPEAKER_00: Then about the son and the mother,
• 31:25
  SPEAKER_00: and then about the father,
• 31:27
  SPEAKER_00: mother,
• 31:28
  SPEAKER_00: and the son,
• 31:29
  SPEAKER_00: and then the father with the daughter.
• 31:31
  SPEAKER_00: Then because the father was quite caught up with everything that was going on with
• 31:34
  SPEAKER_00: the son,
• 31:34
  SPEAKER_00: there was a bit of
• 31:36
  SPEAKER_00: dropping the ball sort of feeling, although the daughter was being understanding.
• 31:40
  SPEAKER_00: And then we started talking more about that.
• 31:43
  SPEAKER_00: And then from that,
• 31:44
  SPEAKER_00: the discussion led from not only how healthy is a team,
• 31:48
  SPEAKER_00: but what each of them could do to contribute to the well-being of the team,
• 31:56
  SPEAKER_00: if you like.
• 31:57
  SPEAKER_00: And they talked about the need of going back to some kind of regular routines that they had.
• 32:02
  SPEAKER_00: So they had a routine about every...
• 32:05
  SPEAKER_00: weekend on the Saturday that they would go for swimming and then they would go for
• 32:09
  SPEAKER_00: to catch just like a pancakes or something together and that's great you know like
• 32:13
  SPEAKER_00: it doesn't have to be the exact stuff but at least some sort of ritual for the
• 32:20
  SPEAKER_00: family ritual to me has got three components it's intention
• 32:25
  SPEAKER_00: attention and repetition so the intention the intention is to take care about the
• 32:32
  SPEAKER_00: wholeness the health after all health means wholeness of the team and then you put
• 32:39
  SPEAKER_00: your if that's your intention then you put your attention to that you devote time
• 32:44
  SPEAKER_00: and attention to that and you do this regularly and repeatedly that fundamentally
• 32:51
  SPEAKER_00: is ritual
• 32:53
  SPEAKER_00: And then finally,
• 32:54
  SPEAKER_00: the sixth strategy is about understanding the fact that when we try to love,
• 33:00
  SPEAKER_00: we love poorly.
• 33:02
  SPEAKER_00: When we love, all of us will love poorly.
• 33:06
  SPEAKER_00: So that means that we would falter, that we would miss the mark.
• 33:10
  SPEAKER_00: That's natural.
• 33:12
  SPEAKER_00: but it's what we do with that, how we could take on the accountability and the responsibility for that.
• 33:19
  SPEAKER_00: And are there things that we need to seek forgiveness for?
• 33:24
  SPEAKER_00: And this could be from the parent.
• 33:27
  SPEAKER_00: This could be from the child.
• 33:29
  SPEAKER_00: And often I would,
• 33:31
  SPEAKER_00: whenever we begin this,
• 33:32
  SPEAKER_00: I often ask somebody who has greater power within the system,
• 33:36
  SPEAKER_00: oftentimes the family,
• 33:38
  SPEAKER_00: but even within the family,
• 33:40
  SPEAKER_00: sorry,
• 33:41
  SPEAKER_00: the parents,
• 33:41
  SPEAKER_00: even within the parents,
• 33:43
  SPEAKER_00: you think about who has more,
• 33:46
  SPEAKER_00: so to speak,
• 33:48
  SPEAKER_00: influence and power.
• 33:49
  SPEAKER_00: And you might want to start from there and then ripple on to the others and to the children,
• 33:55
  SPEAKER_00: to the child,
• 33:56
  SPEAKER_00: to the youth.
• 33:57
  SPEAKER_00: Another thing you could ask as well is to do a little bit more of a structured
• 34:01
  SPEAKER_00: exercise to ask each person the following three questions.
• 34:06
  SPEAKER_00: And you could give out little index cards or post-it notes for them to write.
• 34:10
  SPEAKER_00: You could ask them to say, write down for each of you what is your biggest struggle.
• 34:18
  SPEAKER_00: And then they scribble it down.
• 34:20
  SPEAKER_00: And then number two, they could write, what do you need?
• 34:24
  SPEAKER_00: Even for the parent, but also for the youth.
• 34:27
  SPEAKER_00: What do you need?
• 34:29
  SPEAKER_00: And then three, what are you willing to do?
• 34:33
  SPEAKER_00: In other words,
• 34:35
  SPEAKER_00: What are you going to bring to the table as well?
• 34:36
  SPEAKER_00: What are you willing to sacrifice?
• 34:39
  SPEAKER_00: What are you willing to let go of?
• 34:41
  SPEAKER_00: What are you willing to unlearn?
• 34:46
  SPEAKER_00: And this allows a dynamic conversation because it's going to come not just from the parents,
• 34:53
  SPEAKER_00: it's going to come from the youth and vice versa.
• 34:56
  SPEAKER_00: And that's a very vibrant way to have that conversation around that,
• 35:00
  SPEAKER_00: especially when we could get people to move towards getting more connected.
• 35:08
  SPEAKER_00: And you might ask, well, this is not really family therapy.
• 35:11
  SPEAKER_00: Why are we doing this?
• 35:13
  SPEAKER_00: Just remember something that we said at the outset of this episode,
• 35:16
  SPEAKER_00: that all of us are in a system called a family.
• 35:22
  SPEAKER_00: All of us are, whether we know the family member or not, whether it's
• 35:26
  SPEAKER_00: our blood ties or whether we're adopted, but all of us belong to some way of this.
• 35:31
  SPEAKER_00: And we need to be able to understand that all of us are attempting,
• 35:36
  SPEAKER_00: all of us are attempting to love well,
• 35:39
  SPEAKER_00: but then we falter,
• 35:41
  SPEAKER_00: we make mistakes.
• 35:43
  SPEAKER_00: That's a given.
• 35:43
  SPEAKER_00: It is what we do with that.
• 35:46
  SPEAKER_00: That expands the conversation.
• 35:48
  SPEAKER_00: That doesn't just make you feel like they are what in the old family therapy
• 35:55
  SPEAKER_00: systems theories way of thinking,
• 35:57
  SPEAKER_00: they call it the identified patient.
• 36:00
  SPEAKER_00: We're trying to expand that lens and zoom out for a second and to have that
• 36:04
  SPEAKER_00: conversation to be more inclusive,
• 36:06
  SPEAKER_00: to allow it to have a bigger narrative,
• 36:09
  SPEAKER_00: to hold space for richness in our relationships.
• 36:14
  SPEAKER_00: So there you have it.
• 36:15
  SPEAKER_00: This is for Austin Sparks as well as Ash Burton.
• 36:19
  SPEAKER_00: Thank you for sending this in.
• 36:22
  SPEAKER_00: If you have questions that you would like for me to address, please feel free to send them over.
• 36:28
  SPEAKER_00: You could send them in the substack that you see in the comments,
• 36:31
  SPEAKER_00: or you could write directly to us at admin.com.
• 36:35
  SPEAKER_00: at darylchild.com.
• 36:37
  SPEAKER_00: That's D-A-R-Y-L-C-H-O-W.com and list your questions there.
• 36:43
  SPEAKER_00: And I'll try my best to see if we could answer some of your queries that you might have.
• 36:48
  SPEAKER_00: Meanwhile, feel free to go through the back catalogs of
• 36:52
  SPEAKER_00: Frontiers of Psychotherapist Development and our weekly missive Frontiers Friday.
• 36:57
  SPEAKER_00: There are all kinds of different topics being covered.
• 37:00
  SPEAKER_00: If there are certain topics you wish for us to cover a little bit more, feel free.
• 37:06
  SPEAKER_00: And if you are having some ideas and you would like a place to share them,
• 37:13
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• 37:18
  SPEAKER_00: personalized professional development and that resonates with you,
• 37:21
  SPEAKER_00: write to us as well.
• 37:22
  SPEAKER_00: And we would like to include you for our special guest writing in Frontiers Friday.
• 37:29
  SPEAKER_00: Thanks for listening.
• 37:30
  SPEAKER_00: Glad you could join us and keep at your frontier.