 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. So welcome to this next episode of The Therapy Show behind closed doors and we've got our co-presenter, guest presenter, I don't know how to refer to you, but Steffi Cook who is the other half of Bob Cook. Steffi is on this episode because she's got a wealth of experience working with children as an ex-social worker. How long ago was that? I started working as a children's social worker in the 80s. Lots and lots of experience. And kind of transferring that into the therapy room. Yeah, yeah. Well, I did quite a lot of work therapeutically with children. I worked with children in the town in Norfolk. And at the time, there was a high level of child sex abuse into familial and familial. And so I got involved in working with the police and the team as a child therapist, helping them to recover from that or helping them to process it, at least not recover because that is something that you can recover from really. You just learn to live with it. Yeah, yeah. Wow, that must have been interesting on one hand and quite traumatic for you on the other hand. I've got this thing about, you know, when people talk to me about post traumatic stress and how it impacts on them and things, you know, and to be a witness to somebody else's trauma can have an effect on you just as much as if you're part of that trauma. So that must have been. Yeah, that's how I got into the transaction analysis, actually, because obviously I decided I needed therapy. Yeah, I've got a cousin who worked with quite a high profile case, probably around the same time as you. And it had a massive impact on her. Yeah, so anyway, we digress. So working with children, we thought we'd touch on the different ways that that we work with children in the therapy room, whether that's children on their own or children's with parents, you know, and how that pans out in the therapy room. Yeah, so so what what does a therapist need in order to work with children as far as legislations and different training, maybe? Well, first of all, I would always say what's really important is that you learn a developmental model. Yeah, you know where that child is at and what the deficits are in their development. Yeah, yes. Yeah, I don't really. I mean, we always say to our trainees that if somebody can't verbalize how they're feeling, they're probably experiencing something that's happened to them preverbally. Yes. Yeah. So always, always, whether it's Stern or Marla or Piaget or whoever, have a model in your head about how you're going to work so that you have an understanding of where the deficits are. Yes. Yeah, because they will be stuck in those deficits, and that's the area in which you need to help them get out of. Yeah, yeah. On the therapy, one of the things I refer to an awful lot, regardless of the age of my clients is Pam Levin's Ages and Stages. Yes. I just love, I love that, literally. It puts things into perspective, age-related. Although I think, you know, what she was referring to as a 12-year-old is probably different to what we're seeing as a 12-year-old in 2021. Things have maybe shifted a little bit one way. But yeah, I like a process to follow. I find that one quite useful. Yeah. And so the other part of this, this I think is really important, is that you have an understanding of attachment and the left of attachment, you know, normal attachment, avoidant attachment, anxious avoidant attachment, you know, disorganised attachment. Have a model in your head so that you understand about attachment because growing up children need to have that continuity of attachment to be able to develop normally. Yeah. Very often we'll see that reproduced in the therapy room about how the child behaves, whether they're withdrawn, whether they're not communicating or in some way showing you their attachment model. Yeah. To behave. Yeah. You know that, then you know how to work with them because it's pointless trying to work with somebody, work with a child who has huge attachment issues, you know, by involving them in something that will trigger that. Yes. Yes. What you don't trigger their previous trauma by doing something inappropriate. So you have to have an understanding of the child model. You have to have an understanding of an attachment theory, whether you read Bulby or whoever, it's important that you do that. Yeah. You will get that by the training that you do. So I recommend that you do train. You don't just walk into it and say, well, I've worked in a school so I know about kids. Yeah. That isn't good enough. No. So I am a qualified nursery nurse, so I kind of all the Bulby and all that sort of stuff. I attended your training at the Manchester Institute, the child and adolescent one, and just different techniques of working with children, activities, things that you can do because some children, you know, as you said, they can't verbalize things. They find it difficult to talk about things in a therapy room. So doing activities or things where they can express themselves. You know, I'm an ex-foster care and some of the children that we add, you know, add play therapy, they talk vicariously through play and when the attention isn't on them, often they will talk more freely. Yeah. I remember working with a little girl, she was seven, and in my therapy room I had a doll's house and she played with all the rooms in the doll's house except for the bathroom. Wow. So I knew that was significant, but I didn't push her and it was a fair while before she started to unravel about what happened in the bathroom. Yeah. And so I was so glad that I had that doll's house there because she was able to process that experience, not fully, not six. Obviously, I didn't want to retraumatize her, but I knew that she had stuff locked inside that needed to be released. Yeah, that was a really helpful way of getting that started, getting that process started because I was able to say, you don't ever go in the bathroom. And then she said, bad things happened in the bathroom and so on and so forth. Yes. Yeah. Yeah. And, you know, one of the wonderful things from my experience with children, they have a way of communicating through their behavior. Yes. It doesn't, it's not always this, well, very rarely sometimes the spoken word, but their behavior, it's about looking what's behind the behavior. Yeah. Yeah. And, you know, so very often children will draw something and they will, in that picture, depict exactly what's going on for them internally. Yeah. Or sand play. If you have a tray with things that signify aspects of their life, you know, they'll pick the Superman or they'll pick the witch or they'll pick the dragon. Yeah. So it really helps you to get a sense of their internal world by using those tools and helping them to unravel what's going on for them. Yeah. I think one of the things I'm working increasingly with parents and children together in a therapy session, confidentiality and how much do we share or should we share if we're seeing the child on its own with the family or parents? I think that's really important that you, from the get go, have a, what I call, we call it a three corner contract. Yeah. In my modality, we contract for work. So we have a very clear, mutually agreed process of what's going to happen in the work. Yes. And so in a three corner contract, you've got a contract with the child and the contract with the parents and the parents have got a contract with you. Yes. And so usually what I say is, if I'm going to work with your child, obviously what they tell me is confidential. But however, I'm also very mindful that there will be some things that I will contract with your daughter or your son to share with you. Because I think it's important that you are involved in this process of change. And if it's going to help and support that change for all of you, I would want all of you to work towards that. Yeah. Obviously you've got things like safeguarding. Yes. So you can't contract with the child to say, I'll never say anything to anybody about anything you tell me. Yeah. Because there will be some things that you have to do to protect them. So I think it's important that you are absolutely transparent to say, obviously, I care about you and want to protect you. So if there's something I think I need to tell somebody to protect you, I will. Yes. Yeah. And that's kind of, there's always a caveat to mind, you know, that it's it's really important that they see it as a safe space that they can share things. Yeah. But also, you know, if I feel you're at risk of harming yourself or somebody else, then I need to break confidentiality. One of the ways that I'm increasingly working with children and parents is to kind of have sessions with them both in the room and then do individual sessions because a lot for me, it's it's not being about trauma in the past. It's more about communication breakdown, you know, with teenagers, an awful lot of teenagers. So I think it's important to work with the parents as well as the children because they're the ones that are with them a lot of the time. Yeah. Again, I think that's really important that you make that abundantly clear that let's work together in this. Yeah. And again, you contract for that, you know, I will work with you both. And I might have you separately sometimes just an insight, which is sometimes difficult because people can't always share everything in front of each other. Yeah. Again, the caveat is this isn't about taking sides. This is about working to find a way forward. Yes. I think it's a great skill. And I think I mean, I did family therapy training with the child and family psychiatric clinic that I worked at. And I found that resource so, so very helpful. I think it is a very, very important skill to have. And if you can do that, and stay absolutely in, you know, in the middle and not on either side. Yes. Yeah. Really, really important to completely trust that you are working helping them to work it out to find a way forward. Yeah. Yeah. And I think, you know, for some parents, it does, there can be quite a big fear of being judged on their parenting skills, you know, it's so for them to have a safe space where you are neutral, you're not on anybody's side, there's no judgment. This is about, you know, how we work together moving forward so that as a family, the communication is kind of repaired and you can go on because teenage years are turbulent at the best of times. They are. No one ever goes to university to learn how to be a parent to a teenager. No, no. I think there's a lot to be learned from teenagers and I think it's a skill to get parents to see a different way of using them. Yeah. Because, you know, obviously, if you if you watch Dan Siegel's video on it's on YouTube on the teenage brain, he will explain that teenagers brains go through huge changes. And they're either in the in that everything's brilliant and amazing place or everything's really awful place. They don't have that middle ground. Yeah. But they are at the most creative. And unfortunately, as a society, we come down very hard on teenagers because they are so in it and doing what they shouldn't be doing and, you know, having great time. And we find that I don't know how come we do but we find that irritating and annoying. And we want them to be like us but they're not like us, they're teenagers. Yes. Yeah. We're helping parents to see that is really, really difficult, isn't it? Yeah. And sometimes I think parents just need, you know, information about what's normal. You know, when they can kind of explore the fact that the teenagers behavior is perfectly normal for a teenager, it kind of takes the pressure off them a little bit to allow them to just grow and flourish. And, you know, I find myself so much saying to parents that, you know, if this behavior was being displayed in an adult, we would probably welcome it. You know, they're showing entrepreneurial skills, they're showing thinking outside the box, they're, you know, pushing the boundaries and everything. And just because it's in a little person, we kind of think it's not acceptable. Yeah. Yeah. I think that's absolutely right. And learning to have tolerance and learning to be accepting. Yes. Learning to, I mean, the thing we forget to do is find ways of connecting with them. And we get so hooked up on, you've not made your bed, you've not cleared up. Why have you eaten all the bread? Why have you left the milk out? Why haven't you put your stuff away? You know, why have I come downstairs and found everywhere a tip? Yeah. You lose that contact. We lose that connection. And, you know, and it's hard. I know it's hard because I've had three of my own. We were teenagers. Yeah. But finding a way of communicating. So they're on your side. Yeah. Yes. And so, you know, I was working with a family that had three boys, all teenagers. And I said, why don't you sit down and get them to work out what the sanctions are going to be if they don't consider other people in their behaviour? Yeah. I do that quite often. Yeah. They've got to be on board with it. Otherwise, they're not going to engage. No, no. Yeah. They've said, right, if I keep doing this, then I think it's only fair that you do that. Yes. You stop my pocket money or, you know, you take the Xbox away. I'll agree to that. Yes. Yeah. Because I'm accepting of how irritating it is that you come home from work and I've made a big mess and drank all the milk. You know what I mean? When all I want is a cup of coffee. Yeah. So, it's about learning to be considerate about other people. Yeah. And they forget because they're so into their, yeah, this is amazing. They constantly forget. Yeah. Yeah. And that's that black and white thinking again. It's not that they're intentionally, you know, being inconsiderate. It's just not in the peripheral vision because they're living life. Very quickly becomes deliberate when they start feeling resentful. It very quickly becomes rebellious because you've turned your family into a almost like concentration level of punishment of I'm so angry with you. I'm fed up with you. You haven't done this. You haven't done that. Yeah. And so that will turn into that high level of excitement will turn into resentment and rebellion. Yeah. So it's really important that you you get to get to it before that happens. Yeah. You know, that you become more tolerant and a little bit more accommodating of their forgetfulness and their selfishness and their tendency to only see the world from their perspective. Yes. Yeah. Yeah. I mean, explain it to them. Hang on a minute. I live in this house too and sometimes I get a bit hurt about things. Yeah. My cat's joining us. Got a visitor. Yeah. I think it is and you know, I have it's not easy. It takes a lot of work. Yeah. Yeah. You have to really, you know, sit on your hands sometimes when you feel like you just want to, you know, get angry. Yeah. Yeah. And even in the therapy room, you know, it's quite difficult. I've had, you know, parents come to me and ask if I'll work with their child and their child has been so reluctant to to talk and obviously not engaged in the process at all. You know, and I've gone back to the parents and said this, this is not going to work whatever it is, particularly because I'm only working online at the moment. So it's even more difficult, you know, children have been educated online for the past two years and it's not, it's not how to build a connection. They can be quite reluctant to engage in any form of therapy. Yeah. I think that's because kids are so frustrated and fed up they don't trust. Yeah. And of course, we're not here to fix things for people. People sometimes come to therapy with their children expecting us to fix them. Yes. You really are. There's no problem. Thank you. That isn't how things are really. It's a joint effort. Yes. Yeah. Must be involved. Yeah. And I think, you know, particularly again with teenagers, I know we've not touched on the younger age range, but particularly with teenagers, you know, I'm very aware of being drawn into their game, you know, that they're playing where they are disconnecting, where they're not engaging in things and, you know, I try my utmost to not buy into that, which can be quite difficult sometimes. Yeah, staying out the game. Yeah. It really is hard. Yeah. I mean, people play games because that's the only way they know how to get the intimacy. Yes. Yeah. And the payoff is a negative one if you play that game. Yeah. So it takes a lot of work to help people unravel that and understand that they're in a triangle. They're in a risk to rescue a triangle very often. Yeah. And that's a good technique to teach them actually. Yes. Yeah. Yeah. But we all know that, you know, in transactional analysis, one of the things that we talk about are strokes and there's positive strokes and negative strokes and any stroke is better than no stroke. So if you've got quite a disruptive child in the house and they're getting lots of negative energy, it's a connection. It is. Yeah. And that's why kids rebel. Yeah. You know, they are starved of what they really need. Yeah. And very often, sometimes families have that, that that's their process. That's how they've always been. You know, they give negative strokes instead of positive strokes. Yeah. And it's, it's hard to learn not to do that. It's very difficult to make that shift. I think, you know, working with parents, I'm being an exposter carer as well. We kind of think, but that's giving in. If I praise them for every little thing that they do when they've literally, you know, been verbally abusive with me yesterday, that's me giving in. And it's like, well, that's, that's not how it works. Yeah. But you have to see that as being tested. Yes. You know, that they sometimes don't respond because they're testing out to see how genuine you are. Yeah. And that, keeping that continuity up takes a lot of energy and it's exhausting. Yeah. And I often say to parents as well, you know, for me, it's about being authentic with your children as well and letting them know, you know, my son will come down and I know straight away he wants something just by the phrase that he uses, where mum, I will openly say to him, now is not a good time to be asking. Do you know what I mean? If I know I'm not in a good place, I'm not going to give him the benefit of the dose. He's likely to not get what he wants purely because of the place that I'm in. And I think that's something that often we don't take into account. It's not just about the children, it's about the parents and what's going on in their life that we bring into the relationship. Yeah. Yeah. Even as therapists, we've got our own baggage sometimes. So it's just understanding that how we communicate with others has an impact on both our laws and them. I think that's important. So if I did family work with it, with a mother and child or children and parents, I would always help them, first of all, to really understand their own process. Yeah. Which is why it's important to have them all together. Yeah. How do you do things? How do you ask? How do you give rewards? How do you, you know, when you punish, what kind of punishments do you have sanctions? I call them sanctions, not punishments. Yes. Yeah. When kids get into trouble, how do you sanction them? So I have an understanding of how they work. Yeah. Sometimes I have to help them and pick that and see that that's actually not very useful. Yeah. And like you said, you know, to get, to have time out, to say to a child who's so desperately wanting attention and needing to say, okay, what I want you to do is just go away and do such and such for a few minutes and come back in 15 minutes. Or I will attend to that, but I will do that after tea. So you're kind of setting boundaries. Yes. Around yourself so that you're not hooked into the game straight away. So it's learning that's really important. Yeah. Yeah. Yeah. And it's a skill. And I think, you know, when the younger, we deal with them, you know, one way, we think we've got this parents in Malarkey sorted out and then suddenly all the golfers move and it's like, what? I'm back to square one again. This is a different person. I have no idea what I'm doing with this. And that, that's parenting. You know, the upper end of teenagers allowing them to fly the nest is, is quite, you know, a transition for a lot of parents. They are practicing being an adult. It is. It's when the rose-coloured glasses come off your child and they realise that you're fallible human being. Yeah. We're just winging it. Yeah. And it's, it's how you present as that fallible human being that, you know, actually you say, I'm just the norm. This is life really is. And no, there isn't a Santa Claus. And yeah, I can be ugly when I'm angry. Yeah. It's that kind of reality that if you push my buttons you need to know that, that, that there is an impact and you have to deal with that. So it's all of those things, you know, learning that you're, I remember learning that my parents had sex. Wow. That was really shocking. Don't say that. No, they don't. So it's all of those things that you go through. Yeah. That you have differing views. You don't believe in the same things. Sometimes your parents will say something and you'll think, I'm definitely not on your planet. But it's learning to accommodate that and accept that. Yeah. Yeah. And you know, just to finish off on, I think it's really important as a family to, to explore rules and values and beliefs as well. And every family is unique. I don't think you know, we, we touched on the training. Yeah. It's, it's modifying it for each family because we all have our own standards and values on how we should parents. I always do a kind of what's the worst thing your mum and dad could do for you. And I always do with the parents, what's the worst thing that your child could do to you. And you know, when they, when they say what they say, it's really amazing. Yeah. The things that they come up with that their parent never thought of or the child never thought of. Yeah. And they assume the complete opposite. And that's what we can bring in the therapy room. Just an insight into how the parents are for the children and the opposite. And it, when it goes well, it's wonderful to observe. Yeah. So thank you so much, Stephie, for, for coming on and doing this. No doubts we will come back again and maybe look at the, the younger age working with, with younger children and how we can do that. So thank you so much and I'll speak to you soon. Okay. Take care. Lucky. See you again soon. Bye. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.