Clinical Considerations

There are a range of clinical considerations for Filial Therapists when planning and delivering interventions with expectant parents, infants and very young children. Accessing supervision by a trained Filial Supervisor is imperative; time within supervision is an essential component of preparing to deliver the therapeutic approach. Ongoing practitioner reflexivity is also essential to ensure an optimal intervention is delivered. Three key aspects of clinical planning will now be expanded on: planning with parents; toy considerations and playful interaction ideas; and transferring and integrating skills into family life.

Planning with Parents

In individual Play Therapy, the therapist considers and draws on information from the family and includes the child’s system in case planning. In Filial Therapy, however, and especially when working with whole family systems that include infants, it is essential for parental involvement throughout the therapeutic process. Parental involvement in planning should occur at all points throughout the intervention. Table 7.1 outlines the stages of Filial Therapy with a key concept defined and clinical considerations for practitioners for each stage outlined.

The selection of toys and playful interaction ideas for Filial Therapy families with children during pregnancy, and the early years are informed by Play Therapy (Jennings, Gerhardt, &C Ebooks Corporation, 2011). Practical suggestions for toy choices and playful ideas are summarized in Table 7.2, and extends on the Neuro-Dramatic-Play work of Jennings (Jennings, Gerhardt, & Ebooks Corporation, 2011).

Transferring and Integrating Skills into Family Life

The generalization stage of Filial Therapy is a critical point in whole family interventions. At this point in the intervention, families work with their therapist to reflect on the skills they’ve learnt, consider where these skills may have started to be transferred into daily life, and plan for how these skills can be even further integrated into their family life. Table 7.3 provides a brief overview of each filial skill and ideas for how they can be integrated into everyday family life.

Conclusion

Filial Therapy is a highly flexible model that can be tailored to the individual family’s needs as well as the ages and stages of their children. Growing evidence suggests mental health and wellbeing considerations for optimal growth and development of children begins at conception. Filial Therapy is well placed to meet this need for therapeutic work with whole family systems, especially when children from conception to 3 years of age are included in the family system. Further research into this delivery mode of Filial Therapy is recommended to increase literature and resources for practitioners. Clinical considerations have highlighted three key areas for practitioners to focus on when planning a Filial Therapy intervention with a family system who are expecting a baby or have young children. Careful case planning in conjunction with Filial Therapy supervision is advised in order to work flexibly with individual family systems.

Stage

Key objectives

Clinical considerations

Intake

Establishing rapport and setting the scene for therapy

Careful and sensitive discussion during the intake phase should identify if there is a current pregnancy and the chronological and corrected ages as well as the birth history of all children in the family. Discuss targeted goals to include all members of the family.

Assessment

Demonstrating therapeutic presence.

“Sitting with”

Drawing on intake information, the therapist proposes an assessment for the family. The family is consulted to ensure inclusion of all family members.

Training

Creating therapeutic alliance

Each filial skill is taught and practiced with each parent and child in the family system held in mind by the clinician. Parents are supported to practice each skill using role-modelling as if playing with each member of the family.

Supervised

sessions

Scaffolding, observing and providing considered feedback

Reflect with the parent on parent-child play sessions. Consider each child’s play experiences by supporting parents to use thematic tracking. Hone the parents’ use of filial skills, individualized to each child’s presentation and development.

Review and generalize

Reflecting on therapeutic process and future planning

The therapist and parents review together the entire intervention with a special focus on the therapeutic process for each child and any shifts made. Filial skills are discussed for use in everyday family life for each child. Playful moments are also explored for inclusion in day to day relational encounters.

Home sessions

Making time for family play

The therapist collaborates with parents to plan regular contact to review the home sessions. All children receive play sessions with both parents at home under the supervision of the therapist. Parents track play sessions, themes and shifts more independently with the support of the therapist.

Discharge

Saying goodbye as a therapeutic ending

The therapist and parents plan the ending together. Parents may choose to repeat assessments from the beginning of the intervention in order to track progress and reflect with their therapist. All children are included in ending the family’s relationship with the therapist.

Stage and age

Key objectives

Toy

considerations

Playful interactions

Pregnancy:

Conception-

birth

Forming a relationship. A playful pregnancy, connection through play

Mother and father as a play resource. Music, books, voice, yoga, nature, swimming pool

Gentle stroking, listening to music, talking to baby, dancing, rhythmic movement, swimming, physical exercise, reading or telling stories, walking in nature, mentally holding the baby in mind and sending loving thoughts to them, daydreaming about the future with the baby.

Infancy: 0-1.5 years

“Being with.” Connection, comfort and communication

Mother and father as play resources. Music, books, voice, nature, first toys, safe baby sensory toys and household found items such as: pots and pans, boxes, egg cartons and packaging

Physical touch, stroking, rocking, prosodic use of voice, humming, eye to eye contact interactions, use of facial expressions, holding and cuddling, laughter and giggles, voice echo play, baby massage, peek-a-boo, telling stories, reading books, singing, nursery rhythms, rhythmical interactions, dancing.

Early years: 1.5—3 years

“Joining with,” “doing with” and “holding.” Safe haven and coregulator

Mother and father as play resources. Supervised sibling play. Music, books, voice, nature, introducing more sophisticated toys suitably safe for under 3 years of age

Attachment play interactions such as: peek-a-boo, hide and seek, rolling or catching ball to and from one another, mirror- ing/reciprocal play. Sensory play interactions such as: blowing bubbles, exploring various textured fabrics, ribbon or scarf play, exploring sensory toys (suitable for children under 3 years of age), musical instrument play, and mirror play.

Filial skills

Integration into family life

Structuring

Structuring can be incorporated into everyday family life. Routines and consistency may support children of all ages and stages. Child can be scaffolded when transitioning through different points in their day by incorporating aspects of the structuring skill from Filial Therapy. An example of this would be when a child is given a 5-minute warning ready to prepare to walk to the park, then a 1-minute warning, and finally a “it’s now time for us to walk to the park” completes the structuring sequence.

Empathic listening

Attunement to a child’s needs, verbally tracking their play, moments and interactions and using empathic reflections together form empathic listening. Empathic listening can be utilized from conception through childhood within family life. An example of this would be a parent narrating the movement of the unborn baby as it moves and interacts: “Oh, kicking over here, now moving over here ... maybe feeling like you’ve got lots of energy right now!”

Limit setting

Often when structuring and empathic listening are utilized by parents the frequency of needing to set limits is reduced. Limit setting becoming clear, calm and matter of fact in family life with the inclusion of attunement and empathy into limit setting (as practised in Filial Therapy) supports parents to integrate gentle but clear limits into family life. A clear and consistent approach can be practiced by both parents in filial therapy and they can work together (with the support of their therapist) to find a method of delivering limits which is therapeutic. Therapeutic limits in everyday family life can support children across childhood.

Imaginary play

In Filial Therapy, parents accept a very special invitation to re-enter the kingdom of childhood. For some parents this can be harder than others. Appendix D - Play Time Exercise (Yasenik, Drewes, Gardner, & Mills, 2012, p. 231) can be a useful resource for gauging parent’s own play experiences as they embark on creating play experiences with their children. Once a parent has developed imaginary play skills in Filial Therapy, ideas for transferring these skills can be easily discussed with the therapist. An example of a parent engaging in imaginary play can be clearly illustrated when instead of sitting at a park observing their children’s play, a parent picks up a stick and has a wand with their children as they take turns to cast magic spells on each other.

Recommended Resources

  • • Family Play Observation Hypotheses Suggestions for Leaders (Guerney 8c Ryan, 2012, p. 365).
  • • Play Session Demonstration Notes (VanFleet, 2012, p. 47).
  • • Supervised Session Notes (VanFleet, 2005, p.31).
  • • Filial Play Session Notes (VanFleet, 2012, p. 48).
  • • Appendix D — Play Time Exercise (Yasenik, Drewes, Gardner, Sc Mills, 2012, p. 231).

Discussion Questions

  • 1 Consider your current clinical caseload: Are there any families that you are currently working with that may suit this approach? Why might they be suitable? What might the benefits to the family be?
  • 2 Imagine you are discussing with the family the potential to transition from your current method of therapeutic work with them into a Filial Therapy approach. How would you introduce this idea, the potential benefits, and how the infants in the family could be included in the intervention?
  • 3 Under what clinical circumstances do you think working with families during pregnancy and infancy would not be appropriate for a Filial Therapy approach?

References

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