Woolfe, R., Strawbridge, S., Douglas, B. & Dryden, W. (2009). Handbook of Counselling Psychology, 3.ed. London: SAGE. Del I, II og IV.
Over the past 30 years, the importance of acknowledging children and young people’s mental health needs is grown. Children’s mental health service is divided I four layers;
Layer 1: consists of GP’s and school nurses. In this layer the most important work is to encourage to more knowledge for children and parents.
Layer 2: consists of professionals like psychologists, speech therapists, social workers. Here the focus is on the family problem. They support the work done in layer 1 with supervision, training, consultations and client work through a social model.
Layer 3: is for the children with specific mental health problems. This layer consists of psychiatrics, psychologists, social workers, mental health workers, nurses, play and creative therapists and family therapists. They work from evidence based on guidelines with older children and from a medical model primarily.
Layer 4: consists of highly specialised professionals like psychiatrics, psychologists, clinical nurses and family therapist and they work with very complex mental health problems.
The work in layer 2 consists primarily of the work with parents of children with mental illnesses. The process goes as follows; first the clients are referred from their local GP and the therapist must take the first contact. Now comes the stage of assessment and the client must conform to an agreement of confidentiality and consent. Then the problem is looked at and it is important to acknowledge the difficulty of the situation the client is in. This can be followed by discussion of developmental stages and formal assessment like psychometrics, an assessment summery or a formulation. This can lead to an intervention, consultation or behavioural parent training, child protection, attachment work with a play therapist that can create a close bond, or enhanced parenting support using CBT.
Formulation is created from the 5 Ps – presenting issue, precipitating, perpetuating, predisposing and protective factors. This is from the theory of CBT.
Positive parenting programme is a programme that can provide a safe engaging environment, provide a positive learning environment, use assertive discipline, have realistic expectations (of parents and child), encourage the parents to take care of themselves.
Triple P parenting programme; understand that the parents mental health influences their upbringing and parenting.
It is very important to note that the child is the client even though the therapy goes through the parents. If the child is in danger, the relation to the parents must be broken to safe the child.
Politic tension; indirect work with references does not give findings and that is why the core effort is on direct work.
The psychological services is difficult to access for poor people or more dysfunctional families. Therefore it is important to make them more visible and it should not be as complicated to start in therapy.
Research does not work as good in practice as many parents does not have the possibility to attend every session, they drop out, have to get it in a slower tempo ect. Peoples life are complex and research are not directly transferable to practice.
As no problems are simple or easy to access is it important to have supervision, training, team support and attention to the risk for oneself on home visits, as well as making sure that the child is safe.
The training for counselling psychologists with a specialty in children is not enough, extra learning is needed to be ready for the situations that the work demands. The question is how we learn when no rule-based therapy or learning is provided. The question is, is the training good enough?