‘Our family and our circumstances are complicated. Because of this, I believe it’s essential to allow the children to have a voice. Too often children are overlooked and pushed to the side. In conversations with other families, the parents seem to control what goes on with little thought as to how the children are feeling, or even what they might be thinking. The children are dismissed as being too young or not capable of making decisions.
‘I believe it’s vitally important that children are allowed to express their thoughts and opinions. Their insights sometimes focus on what adults seem to miss or overlook. We try to do our best, but I feel that by allowing children to have their voices heard, we’re helping them grow and learn and feel included within the family. It’s my personal belief that it leads to better mental and emotional health for everyone if discussions between family members are open and inclusive.
‘When I was unwell, the children were very young. As a result, they didn’t get much say in who their carers were, or in making any family-based decisions. The older boys did not get to speak to any of the service providers that I accessed; their opinion was apparently not something that was required by the health professionals, although I feel that perhaps it may have been beneficial for both them and myself.
‘As for the home front, once the children were old enough to voice their opinions, Kate and I felt quite comfortable engaging them in conversations about their care, seeking their opinions and their thoughts. The children felt that being able to have a voice meant that they were being taken seriously and that their words and ideas were valued.
‘Ultimately, I feel that it’s essential to allow the children to express their thoughts and feelings in a safe and inclusive environment. While parents must have their say, I feel there’s a strong argument for involving children in day-to-day decision making. Their words and actions can make a big difference in how we approach challenges and make decisions that inevitably affect the entire family unit.’
Jason’s children speak
Children’s voices matter. We wanted to explicitly include the voices of Jason’s children in this paper. Three of his four children were interested. We invited them to tell us what their ideal practitioner would look like. We didn’t offer any further guidelines, but let the children have free reign to say what they thought in conversation with Jason. The children and Jason were paid for their time doing this work.
‘My perfect psychologist would be able to understand my feelings even when I’m not showing them my true feelings. They’d be able to understand everything I say, even when I’m being obscure. I don’t have a gender preference, I don’t mind their age, so long as they are a good psychologist.
‘They have to be a good listener, and they should be careful not to hurt my feelings. I want them to be able to clearly tell me things without being aggressive. They need to be calm and have a sense of humour. I want them to be reasonable and very knowledgeable about everything.’
‘Someone who is nice and straightforward and good at their job. I don’t have a gender preference. I would prefer a psychologist who is more focused on me, rather than on themselves. They would need to talk to me on my level, not as a child, but as an adult. I would like someone who takes their time and doesn’t jump to conclusions. It would be good if they listened to me.’
‘I would prefer a woman as my doctor. I don’t feel comfortable with a man, I feel that most young girls don’t. I would like her to be nice; someone who listens to my problems and doesn’t disregard them. I feel like a lot of people disregard my problems because I’m 12. I’d like her to speak to me on a level that is equal. I’d like if she would understand what I’m thinking instead of jumping to conclusions based on my age and gender. I feel that I’d prefer her not to make eye contact with me because that makes me feel uncomfortable.’
‘What Jason’s children have shared is that they want to be respected as individuals in their own right, not as extensions of their adult caregivers. They want the opportunity to voice their concerns and have these taken seriously, by someone who values their unique and distinctive perspectives. Jason and his wife choose to allow their children to participate in decision-making around issues that are of concern to them, which is a choice that supports their children to develop a robust sense of themselves as valued individuals with agency in their lives. Hearing a child’s unique voice, and understanding the world from their point of view, is absolutely essential to facilitate this process.
‘As I reflect on Jason’s children’s words, I realise that many of the families that I work with are not as able as Jason’s family to hear and consider everyone’s voices. I wonder about the role of shame in making this difficult. Hearing a child’s voice may sometimes entail hearing that you (therapist or parent) have been hurtful, insensitive, and caused the child distress. Where a parent feels fragile and uncertain of their worth as a parent, they may feel shamed by the child. Shame can be paralysing, but it is also often at the root of angry, retaliatory responses, responses that then shame the child. In these situations, there is a real risk that a clinician seeing a child alone will leave the parent wondering how they are being represented to the clinician, which can further undermine them in their parenting role.
‘When families bring their children for treatment, I want to balance my desire to meet a child and young person fully and respectfully, with an unwavering appreciation for the deep interconnections between all family members. Everything that happens in a family has an impact on everyone else. If this is overlooked, there is the risk of differentiation becoming separation and isolation. When all of the voices can be heard and family members can lean into painful conversations, new and creative solutions to problems can emerge.
‘Perhaps in adult-focused services we need the corrective of hearing the children’s voices, but the opposite may be needed in child-focused services. We ignore the interaction of multiple voices at our peril, and risk alienating families rather than helping them to draw closer to one another in the face of adversity.’
‘As I read the words of Jason, Kyle, Matthew, Karen, and Jackie, I am reminded that the inclusion of children’s and families’ voices serves two purposes.
‘The first purpose is instrumental: when we listen to what children have to say, there will often be some form of benefit. If, like Jason, we include children in decisions that affect them, we are more likely to make good decisions, and less likely to be met by children’s resistance. If, like Jackie, we draw on both children’s and parents’ perspectives, our interventions are likely to be more effective, if for no other reason than we will have strengthened practitioner-client relationships. And if we include the voices of children and families in our research and policy projects, the chances are better that our words, concepts, and frameworks will actually map onto the complex realities to which they refer.
‘The second purpose is intrinsic: to include children’s and families’ voices is to show respect for them as autonomous human beings. People have the right to be heard, especially in decisions and discussions that affect them. Article 12 of the United Nations Convention on the Rights of the Child (1989, p.5) aims to,
“assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.”
‘Like all human rights, the right to be heard does not need to be justified by appeals to benefits. Rather, it emerges from the idea that everyone enjoys certain fundamental rights, simply because they are people.’
‘Jackie’s observation about the role shame can play in a situation makes sense. No parent wants to hear that they’re doing a bad job. I’ve experienced this in the past, and it was unpleasant. Adults tend to be reactionary, and getting feedback on their parenting could lead to further complications.
‘However, if this is introduced in a way that both adults and children can understand, it could lead to a successful outcome. In my experience, hearing from my children that my loud voice often scares them, even when I am laughing, resulted in mixed feelings: shame and embarrassment. However, it was a catalyst to assist me in coming up with solutions that have had positive outcomes. Sometimes, as adults, we have to realise that we’re far more emotionally developed than our children and it’s up to us to make the necessary changes, even if we feel uncomfortable.
‘I also can see how receiving feedback could bring concern and weigh on the mind of a healthcare professional. Going back to the example of Karen’s psychologist, I wonder how he felt when he was told he was patronising and condescending. Though he laughed it off, I often wonder how he felt in that situation.’