Transcript for
Using parallel parent–child narratives to support relationships
Jackie Amos (00:00): One of the key principles is that we work with the two together, but that doesn’t quite make for a parallel conversation. So there are some additional elements of that. Heather talks beautifully about sitting and holding the parent’s hand on one side and the child’s hand on the other. And whenever you’ve addressed one around an event or a memory or something they’ve shared, you turn to the other and you weave their perspective and their story back into the conversation.
Narrator (00:34): Welcome to the Emerging Minds podcast.
Nicole Rollbusch (00:40): Hi, you are with Nicole Rollbusch. On today’s episode, I’m joined by Jackie Amos, child and adolescent psychiatrist with Centacare. Jackie has a wealth of experience in working collaboratively with children and families and has joined us today to talk about a particular approach that she uses, parallel parent-child narrative, which is commonly referred to as PPCN. So Jackie, thank you so much for joining me today. So can you talk a little bit about this parallel parent-child narrative or PPCN?
Jackie Amos (01:10): I certainly can. So PPCN is a storytelling process that was developed by a child and family psychotherapist in New Zealand called Heather Chambers. And I’ve been collaborating with her for well over 20 years now, developing this approach here in Australia. And it’s a lovely gentle way of approaching parent-child relationships where somehow they’ve got offside and lost that joy in their relationship and it’s a process of investigating the whole of the development of the relationship. So it’s a story and it’s a story of a relationship. So you might start right back at the beginning around the time when a parent was thinking about becoming a parent or around the time of conception and all sorts of things can happen around there. You can have surprise babies and planned babies.
(02:15): And essentially you walk through that story with the parent and the child present, looking for all the good things that happened, all the things that brought them joy, all the things that brought them connection, but also looking for times where the story seems to go off track and they’re the points in the story where you pause and really want to understand what happened in the relationship at that point.
Nicole Rollbusch (02:45): So is it the parent and the child together telling the story?
Jackie Amos (02:51): Yes. So this is an intervention where you need both people present, and part of that is because this is their story and so it has to be told together. I guess it’s really important when we’re trying to do relationship repair to remember that the therapist is not the person that this parent or this child is longing to have a relationship with, that actually they’re longing to have a satisfying relationship with each other. And as a therapist you are there to facilitate their relationship, not to become a primary relational partner in their lives. We are going to move in, we’re going to help them and then we’re going to go away. But the person that they have to take forward with them hopefully is the person they long for. So the parent longing for the child, or the child longing for the parent.
Nicole Rollbusch (03:44): That takes me to another question I had for you, which was how do families usually respond when you bring up this approach? Because I suppose sometimes there’s that expectation when you’re working with a family that the therapist will come in and be that person for the child or that person for the parent depending on what service they work in. So when you introduce this approach to a parent and child, how do you find it’s usually responded to as an idea?
Jackie Amos (04:15): Look, I think it’s really interesting in some ways it depends where you’re working, how people respond to the idea. So in a child and family service, often once you start to introduce the logic of the idea, people are quite open to it because parents have often reached out to that service because they’re concerned about something that’s happening for their child. But if you ask how’s the relationship? Do you feel you understand your child? Are they a bit of a mystery to you? How much joy are you getting in parenting? Would you like more joy? Would you like to feel easier with understanding your child? I haven’t really met many parents who answer no to those questions, but it’s not universal. Some people are afraid of what they might find in the story. And I think in those situations, one of the most important things is to find out what it is that often the parent is afraid of.
(05:18): They often feel very protective of the child and feel like there’s information in the story that might be beyond the child’s level of development, and particularly where there’s been trauma or family violence or some really difficult events in the family. And I think in that situation it’s really important to be respectful of those fears. But also there are things that we can talk about to offset the fears so we can do lots of planning and preparation around how might we talk about these events? What was the child actually present for? What is it that they do already know? What is it that they actually don’t know? How do we include what they do know into the story?
Nicole Rollbusch (06:07): Yeah, I really like that point about children being present for things that might have happened and then their parent being worried about that coming up in the story, but acknowledging that the child was present for that moment. So is that a conversation that you would have before starting this process? You’d set up a little bit before jumping into it?
Jackie Amos (06:28): Yeah, absolutely. Something that I think I’ve come to value and understand more and more is the importance of preparation with the parent. The parent is going to be the storyteller at least until we get to a point in the story where the child has their own memories and they’re going to be the storyteller across the really difficult moments because until the parent voices something, a child will often be too afraid to voice a trauma or a really difficult moment. So sitting with parents for as long as it takes to understand any excitement they might have about it, understand any fear, any barriers, work with those together, give the parent plenty of time to go away, think it through and come back and develop a trust where we’ve got a plan, the two adults together have a plan about how we might approach the story. I think that preparation can go a really, really long way to then making the actual PPCN where both are present much more effective.
Nicole Rollbusch (07:40): So going back to some of those key principles, I think you’ve mentioned a few already, but what are the key principles of PPCN and why are they important?
Jackie Amos (07:52): So the idea of PPCN, Heather talks about where it came from and what she was trying to do in developing this intervention was take two ideas that John Baldy, the father of attachment theory put on the table and he said, to work effectively with parents and children and their relationships, you have to work with them in parallel and you have to work at the level of the internal working model. And so what Heather was trying to do was think about how would you do that in real life? These are two really good ideas, what would that actually look like? So one of the key principles is that we work with the two together, but that doesn’t quite make for a parallel conversation. So there are some additional elements of that. Heather talks beautifully about sitting and holding the parent’s hand on one side and the child’s hand on the other.
(08:46): And whenever you’ve addressed one around an event or a memory or something they’ve shared, you turn to the other and you weave their perspective and their story back into the conversation. And the second of those two big ideas of Baldy’s was that you had to work at the level of the internal working model. And we know that internal working models are held in our procedural memory or implicit memory. So the automatic how-tos of relationships and we know that they have within them emotional biases, they make us feel like something’s right and something else is not fitting and they have thoughts attached to them a bit later. So another element of this is to be genuinely and kindly curious about all of those aspects. So curious about how come somebody did what they did. What was the thinking, what was the feeling? Is this familiar? Does it happen often on both sides?
(09:53): Lots of curiosity about not just what happened but what was going on inside each person. Something that I often forget to say when I’m talking about PPCN, that’s probably really important for people to know is that when you’re doing PPCN, you’re only ever talking about the relationship in the room. So if it’s a PPCN between a mother and a child, you talk about that mother child relationship. If it’s with a foster parent and a child, it’s the foster parent child relationship. If it’s a grandparent and a child, it’s the grandparent child relationship because you’re dealing with what’s there in front of you and you can’t know the inner world and the internal working models and you can’t work in parallel with someone who’s not there. So just to underline that, when you do the actual formal PPCN process, the story is the story of the relationship in front of you.
Nicole Rollbusch (10:54): There’s a lot going on when you’re doing this. It’s quite skillful in that sense, isn’t it?
Jackie Amos (10:59): Yeah, there is a lot going on and you do get better at that with practise. It does feel like a lot the first few times you do it. And I remember still the first few times I did it, I actually think I had a list of questions on the desk that I kept referring to and it was very clunky. But I think the thing that I’ve learned is that if you are genuinely trying to help a family, then they’ll meet you halfway if you’re clear that you’re learning and let’s give this a try. So they’re the two really big ideas behind it, but there are some other really important ones too. So always giving the mother what you want the mother to give the child. So we want her to be attentive, we want her to think about the child’s inner world, we want her to be wondering and curious, so we have to do that for her too.
(11:55): And in PPCN, we have to do that for the child. So there’s that being what you want the relationship to be in your relationship style is pretty important. And then there’s, I like to think of them as four elements of a interpretation or four skills about how you’re listening to the story and the things that you want to highlight. And the first of those is good intentions. If we just look at actions, we can be pulled into judgement . But if we take the time to think together with both parent and child about what were they hoping would happen if they did this, or what was the dream, what was the goal? We often find that there are good intentions lurking behind everything, and it’s just that translation from intention to action. That means that sometimes the actions aren’t having the impact that the person wants.
(12:59): But I guess the way I think about this is I haven’t yet met a parent who set out on their journey towards parenting when you say to them, well, did you want to end up in this pickle? Did you want this to be a painful experience? Were you dreaming that the two of you wouldn’t get on? I’ve never heard a parent say, yep, that’s what I wanted.
Nicole Rollbusch (13:20): Yeah. That’s it.
Jackie Amos (13:22): The dream is that they will have a good relationship with their child, and so I think you can guarantee the good intentions are there. It’s our job as therapists to find them. The second is when relationships go off track, we all get caught in blame and shame. And so whenever we come across blame or shame, self blame, other blame, it’s about having a look and finding out in terms of the intentions, in terms of the context in which something happened, why this isn’t really anyone’s fault and that’s not as hard to do as it sounds. It’s often very clear once you’re in the middle of a story and hearing detail that the mother is blaming herself for something that perhaps came from outside of her originally, but now might be part of her internal world, but it’s still not hers to take the blame for. We’re trying to just eliminate that narrative of blame or shame and say, well, we’re all human and we’re all fallible.
(14:32): Then the next of those is the principles is shared losses. So where things have gone off track, we know that the dream was for things to go well. There are then inevitably things that have been lost from that dream and it boils down to, in many, many different guise is the loss of being the parent they wanted to be, being the parent they longed to be and for the child, the loss of having the parent they long to have, that they deserve to have. That that comes in a different form for every parent and child. And I think the fourth thing is putting that all together and saying, it’s nobody’s fault. It’s just sad. This is very sad that this has happened, that you find yourself off track. And the idea in PPCN is that you are using each of those skills as often as you can through the story and unearthing the story of care and connection that’s gone missing, submerged between underneath the story of pain and disconnection.
Nicole Rollbusch (15:44): Yeah, I imagine that is quite powerful to do that with a parent and a child. What different settings have you used PPCN in before?
Jackie Amos (15:55): So I started out using PPCN in a CAMHS setting, so child and adolescent mental health service. But more recently we’ve been using this in a non-government setting, so we’ve used it quite a lot now in reunification. So where parents and children have been separated and involved with the child protection system and they’re coming back together and using this to heal the relationship hurts that both inevitably carry and these mistakes of meaning and blame, so that shame and blame trying to unravel that and unravel the hurts and fantasies that they both have about what was going on when they weren’t living together.
(16:42): So we’ve been using it in reunification, unify, incent care. We’ve also been using it in foster care and that’s also happened in private settings and across CAMHS where a child has come into the care of a foster carer and they’re building a relationship from scratch and talking about the story of their relationship, how they came to know that they were going to be together and how that relationship has unfolded and how the context of the foster care as family and the family that the child has come from might be different expectations are different leading to models which sends a relationship off track.
Nicole Rollbusch (17:26): Yeah. What strikes me is it’s a way to move past some assumptions that might be being made in a relationship because so many assumptions in all of those settings can be made. And I’ll ask you a little bit about the benefits for child mental health later, but can you talk a little bit about this idea of maybe moving past assumptions and is that something that happens?
Jackie Amos (17:50): I think that absolutely describes what’s going on here, that certain events set up certain assumptions. So just thinking more about different settings. If a child has had a lot of medical illness and the parents had that dual role of nurse and parent, there can be all sorts of muddly assumptions then that find their way into the relationship. And again, PPCN is a lovely way to untangle that, or a situation where a parent has perhaps had to get a grandparent to look after a child for a while and all of the assumptions that go with why, and the child might make up in their mind all sorts of ideas about why, and this can untangle that and give them the story. So I think that’s, in a nutshell, in a way it’s about finding and moving beyond unhelpful assumptions.
Nicole Rollbusch (18:48): Yeah. So it’s like putting it out on the table. Here’s the story, here’s my perspective. What was your perspective? And as you say that weaving, which sounds like a lovely way to work, are there any circumstances where you wouldn’t use PPCN, or you would maybe avoid that kind of approach?
Jackie Amos (19:07): Look, I think there are situations where it’s probably not enough on its own, and I think the strongest indicator of whether it’s going to be enough or not is the parent’s response to the idea. If a parent is given all of the information and they’re really clear that this just doesn’t sit right, then I think you wouldn’t use it because a lot rests on the parent being able to find some comfort with the process. And so that would be an absolute reason not to use it. It certainly has been used to restore some very difficult trauma and some trauma where the parent who’s telling the story has contributed to that trauma. So that isn’t a contraindication, but it does require a parent to feel that they can take that on in a very direct way. And if they don’t, then there are less direct ways perhaps to tackle the same healing process.
Nicole Rollbusch (20:07): Yeah. I wanted to ask you specifically about the benefits of PPCN for child mental health. I think in our conversation those things are coming out, but what are some of the things that you would suggest are benefits that I suppose you’ve seen as well in your practise?
Jackie Amos (20:25): Look, I think one of the things that is important to remember and that really gives us the answer to that question is that children are deeply embedded in relationship. It’s not until four or five that children begin to understand themselves as having a separate self and having a self other boundary, and they’re deeply embedded in relationship for a long time. And attachment theory and all of the theories around intersubjectivity and how parent-child relationships develop, tell us that those are the relationships where we learn about who we are. We learn that we’re loved, that we’re acceptable, that people delight in us, that our ideas are important, that we have our own mind, that we can make mistakes, that the world doesn’t fall apart when someone’s angry.
(21:18): If in a relationship between a parent and a child, those things are going off track, that will have a far reaching impact on the child’s sense of self, on their ability to be effective in the world, on their trust in the world. And that begins to turn into symptoms like anxiety or low mood or behavioural issues and the things that we know we see in children. And so I think that repairing a relationship and making sense of things that don’t make sense is actually incredibly powerful in helping a child to find a different trajectory through the world.
Nicole Rollbusch (21:59): Yeah. And I wonder if that space of openness and being able to be together and share some really difficult things and say some really difficult things enters into their relationship ongoing as well, and they feel like they can talk about stuff more than they did before.
Jackie Amos (22:19): That’s the hope. The hope is that by having these conversations which are very personal, but that give you the skills to have hard conversations, this becomes part of family life and then your job itself, it’s just done. Doesn’t mean people might not come back for some if they get to another stuck place, but that is absolutely the hope with this intervention, is that by removing obstacles and barriers, misunderstandings and assumptions, there’s a clear path where they won’t accumulate again, but they can be talked about as things arise.
Nicole Rollbusch (22:57): Are there particular age groups where you would start using this or can you use it with really young children as well?
Jackie Amos (23:07): Look, I think once a child is verbal, so three and a half, maybe a little earlier for some children, and the main thing is then the skill of the therapist in making the story understandable for a child of that age. So I think three and a half-ish, she’s probably the youngest that I’ve done this with. And like I say, the oldest is an adult child of a parent with their parents. So as long as there’s some verbal understanding, and children understand more than they can speak. So we know understanding develops first and as long as they’ve reached that place where they can play out their concerns and contribute through their play and their actions and some of their simple words.
(23:56): And to be honest, I’m not always great at getting my language down to three and a half. So often the parent can help, which is wonderful. And you can say to the parent, I don’t think I quite explained that, how do you think we could explain it better? It’s a lovely way of bringing that parent into their rightful place as the most important person to this child, not you as a therapist.
Nicole Rollbusch (24:20): So it seems so applicable across age groups and settings. What have some of the challenges been for you in delivering PPCN?
Jackie Amos (24:31): Some of the challenges, often one of the biggest challenges is if a child gets really anxious about the process and then that’s expressed behaviorally. So sometimes we’ve had to keep the dose of story very small and make sure that there’s plenty of other things for children to do. So making sure there’s plenty of sensory toys, plenty of activity. With adolescents, sometimes the challenge is they don’t want to be in the room with their parent. So sometimes we face that by doing the story with each individually and running backwards and forwards with bits of the story. So instead of doing it in parallel in the way that you would with a smaller child, maybe meeting with the adolescent and hearing their day-to-day concerns, meeting with the parent and hearing the story and then seeing if you can find the beginning of that pattern that the adolescent is now unhappy about in that early story. And then gradually bringing those stories together.
(25:38): There’s always the curve ball, there’s always the story you didn’t expect to hear that nobody told you about, that suddenly turns up in the narrative. And I think then it’s just staying really true to those principles. Remaining curious, looking for the good intentions, looking for where mistakes have been made around fault and loss and just keeping on exploring in that gentle way until things settle. So they’re the ones that come to mind. I think too, just developing that initial trust in the process, that’s quite a challenge on the therapist side. When you do, it’s hard to work any other way because it’s such a nice way to work.
Nicole Rollbusch (26:22): How long does this process usually take? Is there set amount of time or you just led by the parent and child really?
Jackie Amos (26:31): It depends on the situation you’re facing. So where something has been basically okay and there’s an event where things clearly went off track, you might work with that in one session. If you, in a situation where there’s intergenerational trauma that a mother has brought some very difficult traumatic memories and trauma context to their parenting and you’re trying to unravel something that perhaps has been there from conception it’s going to be a longer process, but it’s not usually a very long process. So firstly, children, sometimes we often have a 60-minute hour in the therapy world or a 50-minute hour. Children sometimes can’t do that. So sometimes these sessions are 30 minutes or 20 minutes or 40 minutes or 50 minutes.
(27:22): And I think often we’d spend a lot of time on the very early time because you often get so much goodness and connection in the early pregnancy and leading up to birth after birth, things are often quite good for a time there. So you really want to build that story of that good foundation. But this is not a long-term therapy, so we are looking at sessions six or eight or 10, we’re not looking at continuing this storytelling process forever. Other things may be needed, but often when you clear the pathway in their relationship, other interventions become more effective, because you’ve got a very strong parent-child relationship to then do those other interventions together. You’ve got that cooperation.
Nicole Rollbusch (28:08): Yeah. So what would you suggest for anyone listening who might be interested in learning more about PPCN?
Jackie Amos (28:16): Well, I’m very excited to say that we are developing a formal training package in Centacare Adelaide, and so into the future, we’re going to be able to offer training in this form of therapy. It hasn’t been as widely available as a training up until now, but we are really hoping to remedy that.
Nicole Rollbusch (28:38): Yeah, that’s great. Fantastic. And is there anything that people can do to, I suppose, register their interest at all?
Jackie Amos (28:46): The best way to do that would probably be to send an email to our inquiries email address, which I think can be found on our website, and then they’ll know who to direct that to. We are still a little way off, so we are hoping it’ll be in the next 12 to 18 months, it could be a little earlier. So yeah, that will be a good avenue as a formal training programme. There are some people around who are still using this in private practise, and if you found someone who was using this, then they could obviously also support people. But that wouldn’t be a formal training, that would be more of an informal learning process. So we’re hoping we can fill that gap.
Nicole Rollbusch (29:31): Yeah, that’s excellent that there’s something formal coming out because it does sound like such a lovely way of working, and there are many benefits to these conversations.
Jackie Amos (29:42): I think I can say hand on heart that after I learned this and had become used to using it, that I conduct every conversation with a family with this lens on whether I’m doing a formal PPCN or not. So I think it’s just a very gentle way to do some quite deep work and a nice framework for having helpful conversations.
Nicole Rollbusch (30:07): Yeah, I think that speaks volume. So it can be that framework for all of your work, regardless of whether you’re actually, like you say, doing the formal PPCN. Is there anything else you’d like to add before we go?
Jackie Amos (30:20): I would like to just say is, although it sounds quite magical and it actually feels quite magical to do this work, the thing that I always go back to is that the families I could work with effectively before I learned PPCN and the families I could work with effectively after I learned PPCN, it just increased my capacity to be effective as a practitioner because these are the fundamental hurts that if we carry them ways down. So I feel very strongly that it’s a very nice way to help a lot of families move beyond difficult times.
Nicole Rollbusch (31:04): Lovely. Well thank you so much for joining me today, Jackie. I really enjoyed learning more about PPCN and sharing it hopefully to a bit of a wider audience that might’ve heard about it before. And all the best with developing the new training package as well with Centacare.
Jackie Amos (31:21): Thank you. And thank you for inviting me. It’s been an absolute pleasure.
Narrator (31:28): 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 or Youth Mental Health Program.