NUMBER 1090 • 21 NOVEMBER • Relationships
Implicit in a young person’s consultation with mental health services is a triangular system of relationships:
Each of the three will have different knowledge, wishes, expectations, concerns and feelings which will influence the resultant interaction (Pearce, 1994). The child’s, parents’ and professional’s voices do not, however, carry equal weight and are not equally articulated, heard or acknowledged. Nor are their positions necessarily independent of each other’s. In particular, the child’s psychiatric disorder may well be causally related to the parent-child interaction.
The aim of the child psychiatric work includes alleviating the distress of the child, reducing concerns about the child’s behaviour or well-being and improving the relationships between the child and his or her family and peers. There is a quest for new, joint understandings. In the process, there may at times be a lack of consensus, or differences and disagreement may arise. The alignment of agreements and differences will vary from case to case. There may be situations where child, parent and professional each hold different viewpoints. More often, there is a measure of agreement between two of the protagonists. The nature of the alignment is of considerable significance for the child. If, for example, the child’s viewpoint is acknowledged by neither parent nor professional, the child will feel both very isolated and powerless and unless independently represented may, indeed, remain so. An example of such a situation was reported by Graham and Foreman (1995), concerning an eight year old girl who presented with a pervasive refusal syndrome (Lask et al., 1991). Following hospitalization and gradual recovery, she refused to return home, resisting the wishes of both her parents and the treating clinicians. In other cases, the child and parents may together disagree with an opinion or proposal put forward by a clinician. Although from the latter’s point of view the child may then be in a very vulnerable position, the young person continues to experience an alliance with his parent(s) or primary carers. By contrast, the comfort which the child might derive from being supported by a professional in a situation of conflict between the child and the parents is vitiated by the child’s distress at the fact of the conflict. This is important because rarely does a child come to feel entirely free from his or her primary caregivers, whatever their capacity to meet his or her needs.
Glaser, D. (1996). The Voice of the Child in Mental Health Practice. In Upton, G., Vaarma, V. and Davie, R. (Eds.) The Voice of the Child. A Handbook for Professionals. London: Falmer Press. p. 79.