Transcript for
Child mental health implementation strategies – part two
Jane Walch (00:00): It’s really good to be transparent with kids and families when you see a block. So when you see something’s not quite right here, or something’s not moving like I thought it was going to move, or perhaps the tool’s not quite developing as the way that I would’ve anticipated it to go to the child and also go to the family and say, “Hey, we’re at a bit of a crossroads.”
Narrator (00:24): Welcome to the Emerging Minds podcast.
Chris Dolman (00:29): Hi, everyone. My name is Chris Dolman. This is the second of a two-part episode exploring therapy for enabling children to actively participate in developing and tailoring interventions that can support them in dealing with the problems they’re facing. We explored this theme earlier this year, when I met with some practitioners who worked with children and their families, and I also accompanied their children in conversations with psychologists and other professionals.
(00:55): In the first episode, we explored a key question. How might practitioners go about sharing their practice wisdom and expertise with children without erasing children’s experience or inadvertently disempowering them? We’ll be exploring some practice ideas for responding when children and families experience setbacks in dealing with problems, as well as some practical ideas for future proofing children’s newly-acquired or developed or discovered skills.
(01:24): We’ll again be hearing from three of these practitioners I’ve just mentioned. Angela Coppi, Jane Walch, they’re psychologists with Adelaide Paediatrics, and also Sara McLean, a child psychologist from Emerging Minds. We’ll also be hearing from Jess and Emi to have Emerging Mind partners who’ve contributed to the development of our practice strategies series of e-learning courses. They’ll be sharing from their lived experience of working with practitioners who’ve been consulting with their children around their children’s mental health and wellbeing.
(01:52): If you’re interested in any of these free or others, please visit our website at emergingminds.com.au. But for now, I think as practitioners, we recognise that even despite the most careful preparations and collaboration in tailoring interventions with children, things don’t always go according to plan. Interventions aren’t always as helpful as we would hope. I asked our interviewees about those times when children report that they haven’t implemented a tool or technique that’s been discussed in practice in therapy. Or otherwise, when a child might have tried a tool or a technique that just hasn’t been useful. It hasn’t made a difference to the problem. What kind of guides them as they respond to these circumstances? Firstly, here’s psychologist, Sara McLean.
Sara McLean (02:43): To set up right from the start an expectation that this is a learning journey and learning journeys come with setbacks. They come with failures. They come with the highs and the lows of life. And so, the best plans will go. So I think that’s an important expectation to set up with children and parents right from the start.
(03:06): Then I think the next most important thing is really being careful not to, I guess, inadvertently lay blame. As a therapist working with children and families, one of the first things I would do would be to lay the blame on myself. I will open that up as a possibility. I might say to children, “Well, it’s quite normal for things to go wrong. That’s because I haven’t used the right words to explain it. And sometimes it’s because what I’ve asked you to do is too tricky, or sometimes what I’ve asked you to do takes too much time.” So I kind of would rephrase it that way because children, and it’s actually quite common for me to use too many words to explain things to kids. It also provides them an opportunity to say, “Well, yeah, I didn’t actually agree with what you asked me to do.”
(03:57): So I might phrase it as lots of kids find that I’ve asked them to do too much or a lot find they don’t have time. Are any of those things, what’s more true for you? So I’d explore it that way. The other thing I think is important in the context of setbacks, is that what we’ve learned from growth mindsets in children or in adults for that matter, to see that failures are learning opportunities. So reframing the conversation as, “Well, oh, I wonder what we’ve learned out of that experience? Maybe we’ve learned that I’ve asked you to do something too tricky right now. Maybe we’ve learnt that morning time is not going to work because things are too busy. So what have we learnt out of this failure? How can that shape what I’m asking you to do next time or what we work out we’re going to do next time?”
Chris Dolman (04:47): I really appreciate hearing about Sara’s attention to patients of therapy and making sure that the child knows whose responsibility it is that the consultations are helpful. Psychologist Angela Coppi describes her approach.
Angela Coppi (05:01): I always explain to them at the very start that I’m not a magician and I can’t magic away their problem. And if I would probably start with my own problems first. But I can give them ideas and we can work together as a team to try and manage some of those problems in a better way. My job is to offer you a whole lot of different ideas. You might find some don’t work and there’s going to be no one particular strategy or technique or tool that’s going to work a hundred percent of the time in every single different situation.
(05:32): So I always let kids know that I’m going to help provide a toolbox. And so, we’re going to learn lots of different things. If this didn’t work work, was it the situation that impacted on its success? Or is there something else that we could have done a little bit differently? Can we tweak that strategy or do we need to try a whole completely new strategy? So predicting what is going to happen, I think is really helpful when I’m setting whatever homework task that you are going to use this strategy of diffusion, for example. But your brain is going to come back to you and it’s going to give you that sort of gain so you need to repeat the strategy. It’s not going to get rid of that thought completely. You need to keep trying and keep trying. And if it doesn’t work next time and think about something else that might work better.
Chris Dolman (06:15): Jane Walch talks about the importance of being transparent and understanding how children feel when tools or techniques don’t seem to be helpful.
Jane Walch (06:23): It’s really good to be transparent with kids and families block. So when you see something’s not quite right here, or something’s not moving like I thought it was going to move or perhaps the tool’s not quite developing as the way that I would’ve anticipated it to go to the child and also go to the family. We’re at a bit of a crossroads and I want to check in with you. How are you feeling? Do you think that we’re at a bit of a crossroads as well? Are you feeling like we’re a bit stuck? We’re not kind of moving forward? Because that’s how I’m feeling. I’m wondering how you are feeling too.
(06:55): And kids and families respond really well to that rather than just keep moving through. Because also what it helps them to do, because quite often you’ll get kids that don’t want to tell you that something’s not working because they’re worried about how you’re going to react or respond or, “Oh, I can’t tell Jane that I didn’t practise that or that didn’t work for me.” So if you are modelling that too, “I’m a bit stuck,” and then it makes it feel okay for them. I wonder if you are feeling a bit down or a bit sad or a bit annoyed that this didn’t work for you. Because you tried hard and you practised and we worked, and then you’ve gone away and you’ve tried it again, and it hasn’t worked. Just being able to acknowledge that must be a bit hard for them and seeing where they go with that. Because I might be like, “No, it’s cool. It’s fine. I’m used to it.” I’m used to it. What does that mean? But acknowledging where kids are at and that they can sense from an adult that they get it, is really important.
Chris Dolman (07:58): Jane’s comments also have me thinking about how, if we hear from kids that they are feeling a bit flat or discouraged, we can be curious about how come they’ve still come along to the consultation despite this encouragement. How come they haven’t given up? I think this can help build or regain momentum. Here’s Jane again.
Jane Walch (08:18): You just got to try somehow keep them engaged, keep them interested, keep them thirsty for what else could this be like? So, are you ready to try something new again? Just keeping it a bit light and keeping the energy there, because the failure stuff can get a bit heavy.
Chris Dolman (08:34): I asked Jess, there’s a parent about this. She described different metaphors that can help with disappointment and discouragement.
Jess (08:42): I think especially when you engage that child in that process, you become an explorer. You look over it with that fine magnifying and you see, “Oh, maybe we missed that last time.” Or, “I’ve known other kids that I’ve done this and it worked better.” So it’s about how can we all get on the same another go rather than focusing on the not doing it. The focus needs to be about how do we do it better next time.
Chris Dolman (09:16): I asked Angela and Jane, when children return and say that they didn’t give the tool a go, they didn’t try, how do they respond?
Angela Coppi (09:24): We have a discussion about why it didn’t work, why didn’t you do it. Then try and problem solve some ways to be more successful in the future. Was it that you forgot? Was it that there wasn’t enough time? Was there a crisis that happened? I think a lot of the times my family’s priorities and so something does tend to happen within the two weeks that I see them that is always more important than whatever it is that we have been talking about. So, it’s about trying to find out why it wasn’t actually done and see if we can troubleshoot a way to try again the following week. So, I don’t ever throw it out. Let’s come back to it and let’s try it again this week.
Jane Walch (10:04): My initial response is not to shame them for not doing it. Really, the focus is on the fact that they feel comfortable to tell you that they didn’t do it. That’s important that they didn’t feel nervous or worried about my reaction to that. Again, in the preparation it’s always important, I think, to talk about to kids and the families about we’re going to try different things together. Again, I’d be, “Yeah, that was pretty cool.” Or some of them are, you’re going to come back and go, “Oh Jane, don’t make me do that again.”
(10:34): So, this is you, me, mom, and dad all working together. We’re a team and some things are going to work and some things aren’t going to work. The best thing for me is that you can all come to me and say that didn’t work because then I’m going to know which way we need to keep moving forward. It’s not this way. It’s this way. Can we have a think about why? What do you reckon got in the way? Is it that you didn’t remember? Is it that you were waiting for mom and dad to remind that you walked out of here and you just forgot? What do you reckon it was? And see whether or not they can have a conversation with you about that. Maybe it was too tricky. Maybe they went to do it and it was too hard. Okay, all right, so maybe we need to take five steps off it. A tiny, if this was one jump, maybe we need to make that jump smaller for them to practise.
Chris Dolman (11:22): Jane goes on to talk about the importance of taking a closer look at what didn’t work to discover aspects that did. She highlights the importance of taking care about that.
Jane Walch (11:33):
I’m really interested in what parts of it. Because quite often it can be that two parts of it actually were kind of okay. Three parts weren’t. It’s also when you break it down, what often happens is the whole thing gets bundled into, “Oh, that didn’t work, that’s not good” But when you break it down, “Oh yeah, actually that part did all right. Well, let’s keep doing that part, but let’s get rid of this bit and try this as well.” So I’m really mindful that the overall response is often not helpful. Then when you break it down, it’s like, I wonder if this part actually was okay.
(12:07): And sometimes the language is interesting too, because instead of saying a couple of parts where, oh, they were helpful, they were really good. It doesn’t need to be that strong. The language needs to be a bit light-y. But sometimes we go to, when we’re trying new things and families are trying to implement something and children are trying to implement something, they think it has to be great. “Oh, that was a really good outcome.” It doesn’t need to be so big sometimes. Sometimes the success is just okay, just a little bit different.
(12:37): So it’s about helping kids to notice those little things, because then when you’re using your tools and you’re like, “Ah, so this part,” and you’re really trying to get them to hone in on specific, the little things, it’s a lot of work for them. They’re too quick to jump to not didn’t work. See that little moment of “Ah, yeah,” and just we might sit up a bit straighter or we might move in our chair. “Oh, yeah,” the excitement in that. Also with that excitement and that’s where you want to just grasp and go, “And how about we try the next step three and four? And imagine if we’re feeling like this now, what we’re going to feel like if three and four also help us feel different too?” But you got to pick those moments and sometimes they can be fleeting. And if you miss, you got to come back to it too.
(13:26): With the help of mom and dad, with parents or primary caregivers to be able to be … because you are an hour a fortnight or an hour a week, if you’re lucky in their life, to be able to help them to notice those little times that do make some changes. It’s really important as well. Acknowledging that was hard to go through that and then have it not work, and to still have some energy to keep going, you still got something in there to try something else. What do you reckon? I reckon you do.
Chris Dolman (13:55): Jess also shares about what’s important from their perspective as a parent in terms of how a practitioner responds when the child experiences some sort of setback.
Jess (14:04): Maybe the practitioner can acknowledge and say, “Maybe I didn’t think this through enough with you. Where do we need to change?” Was it the wrong time of the day? Is it the wrong colour? Whatever it is that’s, I guess, made it not happen and go ahead. As the parent, if you’ve got that practitioner, making the plan with the child to have another go at it, the parent can then feel like they’ve got some, I guess, direction about how to support it to happen next time, even if it hasn’t happened yet.
(14:39): If you’ve got something that’s just not working or there’s that block, the practitioner could just practise it with the child in the room as well. Like, “Let’s have a go. Let’s role play with the parent and get them to act like the kid in the situation.” So it kind of brings that fun element back to it of like why are we doing this and what are we trying to do with it? Let’s have a practice where there’s no pressure. There’s no circumstances that are going to explode into bigger things. Let’s have a practise and be a bit silly with it. Then the kid’s more likely to engage with that again maybe in those moments.
Chris Dolman (15:16): I really appreciate how Jess has described the approach there, the practitioner taking it on board to change things around, to keep it light, a bit like putting fun back into failure. She goes on to talk about noticing small successes.
Jess (15:28): I think it’s important to highlight success was in that because I think even when there’s failure, the tool didn’t work, or slipping back into some old habits, there is still something that did work to begin with. So it’s about highlighting those and pulling those out and move forward with success next time. I think that every time we have a go at something, that we are getting better at it over time, that things take practice. Sometimes things are just tricky, and sometimes we fail and that’s okay too. I think it’s really important that they know that there’s always another chance to have another go. There’s never a failure so big that we can’t come back from it.
Chris Dolman (16:14): I asked Emi what she hoped, as a parent, you know, the practitioner would explore in response to hearing from a child about a setback. She reflected upon the importance of putting the focus on the context and the circumstances surrounding the child’s use of the tailored technique.
Emi (16:30): Well, I think it would be really important to see the practitioner making sure that they didn’t put any pressure on the kid, talking about the context, maybe even an example. Like a situation where maybe this solution could have been useful and it wasn’t used, let’s explore that context a little bit. Maybe exploring that context will allow for different solutions to come into place because it moves the shift from them being a failure or not doing something right to it being something about, “Well, it’s not about me, it’s actually about the circumstances.” It shifts that burden of blame and responsibility.
Chris Dolman (17:07): Thank you Emi and Jess for those insights. Of course, we know that sometimes significant or multiple setbacks can actually have children and families and practitioners feeling stuck in the problem. Sara McLean talks about pausing to reverse changed and how things might be different from when the conversations first began.
Sara McLean (17:29): Sometimes it’s really useful to go back through case notes and look at how far the family has come because often it’s normal for families go through periods of being stuck or additional stresses, or you are you’re missing something as a therapist or whatever. But it’s normal to have those ebbs and highs and lows in family’s life and in the progress. But overall, sometimes it’s helpful to say, “Oh, okay, right. That’s actually changed a lot since when I first met that family.” Personally, I find that being able to look back, to look forward, is a really important skill for families to have as well.” Maybe little gains like a child was only attending school for an hour and now they’re staying up until lunchtime. That’s awesome in a period or a year, for some children, that’s a massive gain because of all the other things that opens up for them. So I think definitely you can use that same kind of looking back and noticing change. Sometimes I’ve called it optimistic perseverance, sort of, you’ve got to know change in order to be able to persevere in the longer term.
Chris Dolman (18:31): I asked Jane Walch, what is it that supports her as a practitioner, not to be weighed down by discouragement or disappointment when the child and family experience setbacks in dealing with problems?
Jane Walch (18:43): Everyone in here is kind of like, “Oh gosh, nothing’s really working.” It’s important to call that out. It’s a similar sort of thing like with that heaviness and the disappointment about, “I don’t know whether I want to keep going with this or keep trying different things because nothing seems to be working,” and to get that out. Is that how everyone’s feeling? Because I feel a bit like that. Is that how you’re all feeling? Then, it’s a good moment to pause and reflect and go, “Okay, so we’ve had five sessions, one session, two sessions together. Has there been anything that you’ve gone away and that sat okay with you or that you’ve felt like I want to try that at home or I’m going to think about that a bit differently, or you’ve noticed your reactions to something are a bit different. So try and to reflect a little bit to see whether there’s anything that I have noticed?”
(19:29): Because I think during that process, again, something little that’s been okay. Just okay. And that’s often enough to talk about that and to build on from that that makes families go, “Ah, it’s not all terrible. No, it’s not all, it hasn’t been a waste of time.” There’s been snippets. Because it’s unfortunate, isn’t it, how our human brain works, that we often go into this negative box where everything becomes, we catastrophize and then everything becomes, “Oh, that was all bad.” Well, actually it wasn’t all bad; and sometimes, it was in that reflection to go, “Oh, I remember that. I remember that session when we did that little thing. That was okay or pretty good.”
Chris Dolman (20:10): Jane’s emphasising the importance of noticing progress even in the context of setbacks or disappointment. Of course, many practitioners know that sometimes a problem returns to the child’s life. This also can leave the child or the family feeling like a failure. I asked our interview guests how they go about limiting the chances of a sense of failure happening when problems do return in the future. Jane Walch spoke about the importance of children’s experience and preparing for this kind of eventuality.
Jane Walch (20:40): Initial acknowledgement of what’s that like that it’s come back and how’s the child feeling about that. Are they upset? Are they annoyed that it’s come back? What are you feeling about that? Is there a sense of frustration in the house? Sort of acknowledging what’s going on for them now in terms of the re-emergence of whatever it is. Again, I’m going to go back to the importance of the prep when you’re working with families about things come and go. And it’s not that we ever fully stamp out or get rid or things disappear. What happens is we get better at managing them. And so, each time they do emerge, if they do, that we are better equipped to deal with them. Sometimes they can be slightly different. Different tweak on things, but we’re still we’ve got some new skills or new tools that we didn’t have before.
(21:30): I talk about roller coasters. I talk about waves. I like the wave because kids usually have been to the beach, know what waves are and waves can be big. And sometimes problems can be big and sometimes problems can be small. But what we know about them is that they always come down. Worries, they always come down. We’ve just got to learn to ride it. How do we write it? We get our boogie board. What’s going to be our boogie board?
(21:51): But how, I guess it’s also good for families to reflect on at this time. The fact that it’s come back, okay, is one thing. Is it different at all? Did you think differently about it? Did you manage anything differently about it this time than you did last time? I think it’s unhelpful if families go away thinking that this may never come back. The sense of failure, so much worse if it comes back and they think, “But hold on, this wasn’t supposed to happen.” It kind of can. It may not, but also may.
(22:22): But you also got so many more tools to be able to manage it. And so, I treat that like an exciting thing. Like, look at this. You’ve got some really good tools that you can go and conquer the world with at the moment. It’s your turn to give this a try. So I always then have a period of time where I send them away with them. Sometimes it is a tool kit. We actually make a tool kit. I send them away and then I get them to come back after a period of time. So it could be that it’s at the end of the term or it could be at the start of a new year that I invite them back in. Sometimes that’s just enough to go, “Yeah, I’ve done this. I’m feeling really good about this.” It’s also good for them to celebrate therapy in a positive light too. That therapy is not always when things are really bad, but it gives them a chance to go, “I’ve got to try these new skills.”
Chris Dolman (23:11): Sara McLean reminds us that the process of collaboratively tailoring interventions with children can in itself help future proof children’s new skills.
Sara McLean (23:21): It maybe their first experience for a child. It may be their first experience of working in a respectful way with adults. It sets them up, I think, for skills to negotiate whatever barriers and obstacles or challenges or opportunities come up for them in the future. So it’s kind of very future-focused strategy if you like. So what we’re trying to do is not just solve this problem or this issue for here and now, but also set up a way of approaching and problem solving that children can take with them into the future. So we are looking at trying to validate their expertise, their past experience, build a sense of advocacy, and then, but also give them transportable skills into the future. Always keeping in mind that we are here for a short time in kids’ lives, but what we want is for them to have skills that they can take with them wherever they go in life.
Chris Dolman (24:18): So let’s now hear from parents Jess and Emi for their ideas about what a practitioner can do to support a child and a family, to ensure that the skills and tools and techniques that they’ve developed can endure into the future.
Jess (24:31): I think it depends on who you’re directing that conversation with. If you have figuring out language that works for them, is it about levelling up, like that gaming language. Is it about levelling up that skill? Is it about what is the next step? Is it about how do we go bigger next time? The age of the child’s going to change and where they are at developmentally changes, and their ability to cope with that change can be really tricky when that tool doesn’t work. So the practitioner could have those conversations level for this skill or technique. Or what’s that level up.
Jess (25:12):
I think if the practitioners had that chance to explore when things haven’t worked with the child and the parent, it gives them permission to then do that in the future together. They’re having conversation starter or a tool that they could use to unpack what worked, what didn’t work, and how we change it. If the practitioner is around, of course, there’s that chance to go back and reevaluate. But if you’re trying to be able to do this in the future by themselves, I think having some sort of tool or reminder, something that’s there that they can go back to, can be really helpful.
Emi (25:50): So I think if they can find different ways to reinforce new skills, role playing, I think role playing is … not everyone wants to role play, but that’s something that I like doing. Some kids will hate it, but some kids would love it. Even just having costumes and things, make it into a really fun thing and make a whole session out of it. And make a whole session out of it, doing that mind mapping, and then maybe even putting that into a poster and printing it out so that can be put on a wall at home. Making it into little palm cards, so that you can have the palm cards stuck up. I think that by making things fun and creative, you are learning in a different way.
Chris Dolman (26:34): Angela Coppi talked about how creating tangible reminders for children are important aspect of her practice.
Angela Coppi (26:39): Making things visual. So I always write down what we have done in session. I’ll be writing notes. I don’t necessarily have worksheets or things like that I give out. I’ll always just have a stack of paper and textas and we will just create our own resources as we go. So I’ll draw pictures and I’m not an artist, so it’s very rudimentary stick figures. Puts the kids at ease, I think, that there’s no pressure for us to be doing high end art. So I’ll just get the craft out and then share with them what is available.
(27:09): Perhaps we can brainstorm some ideas of whatever it is. Usually I introduce something verbally and then whatever it is that we can conceptualise this in craft or in art. So I might give them some ideas around making a bracelet. I’ve got some beads and with lettering. So we might make a bracelet that has a catchphrase to help you remember what it is that we’ve discussed or we could create, it would be something like I said on Canva, an online version of that. So just really getting out different things and seeing what the child gravitates towards and helping them if they need to.
(27:44): I think it gives them something tangible that they can take away at the end of a therapy session and feel accomplished, that I’ve actually learned something. Then it’s something visual that they can draw back upon to remind them of some of the things that we had spoken about. And I find that when kids are doing something, they’re more likely to engage verbally because often families will typically put things up on walls or magnet to the fridge, or some families will then create a folder so there’s something that they can return to. Because quite often we will return to things that we have done. So I think that’s a recency of practice that we know for things to go into the long term memory, we need repetition. So, coming back to things that we have done a few sessions ago, just to review and to see if we need to go over any of those strategies again.
(28:35): Problems do return. And so then we can come back to those strategies. I can have those conversations and say, “We’ve been here, we’ve done this before. Let’s go back.” Then because whatever the notes are that I have given the kids get scanned into our filing system. So then I’ll go back up on the computer and say, “This is the conversation. Do you remember?” And we’ll go through those notes and then make another visual for them to take away to remind them of we’ve done it before, we can do it again. I’ll ask permission and say, “Is that okay if I share that?” Sometimes when the kid is using Canva or they might have really good catchphrase, I’ll say, “Actually, can I keep a copy of that?” We’ll keep it up and we’ll display it. So always we’ll do that with their permission. But I think kids like to know that they’ve been helpful in some way. It makes them feel good.
Chris Dolman (29:23): To the end of this podcast, thanks for listening everyone. We hope you’ve enjoyed it and found it interesting and valuable. Please listen to the first of this two-part series if you haven’t already. Thank you once again to our guests, Emerging Minds, family partners, Emi and Jess. Thanks for sharing your insights from your lived experience. Thanks also to Angela Coppi, Jane Walch, and Sara McLean for your generosity in sharing your practice reflections from your work with children and families. Thank you everyone.
Narrator (29:53): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.