Communication with therapist, supervisor, and other agencies

Given the potential for risk, the seriousness of the young person's psychological predicament, and the consequent anxieties likely to be generated, the young person's therapist and the parent worker need to have regular communication outside of the therapeutic sessions, in addition to review meetings with the family. Such communication needs to be sufficiently regular to lessen significantly the likelihood of acting out by the family, their workers, or the network. A pattern of meetings should ideally be agreed between the clinicians at the outset. These could take place face-to-face or by telephone. Additional communications (such as by telephone and email) will also be necessary in some cases. This has implications for the way confidentiality is discussed with the young person at the start of therapy.

The young person's therapist and the parent worker will probably need to share a developing formulation of the young person's internal world, paying attention to the nature of internal objects, anxieties, and defences. They will also discuss the impact of the treatment on the parents and family and the young person's functioning in the external world - such as at school, at college, or in a residential unit - and on his or her peer relationships. It will be necessary for the young person's therapist to know something of the psychological resources and limitations of the parents in order to understand the young person's home situation. Any issues concerning the young person's siblings and extended family members will also need to be shared between the two clinicians.

The therapist and the parent worker need to strike a balance in achieving good communication in this way without blurring the distinction between the two pieces of work. If there is a high level of discussion between them, this can, to some degree, serve a peer- supervisory function, including containment. The transference and countertransference experiences in which each clinician is participating (with the young person or parents) will, however, influence how each clinician hears the other's clinical material and also affect each clinician's identifications within the family dynamic. This holds the potential for distortion to understanding, and it may unhelpfully shape what each clinician offers to the other from a supervisory perspective. Too much discussion between the young person's psychotherapist and the parent worker runs the risk of an unhelpful amount of information and views from each of the family members being exchanged between the two. This can become lodged in the clinicians' minds and get in the way of their unprejudiced emotional availability in subsequent sessions.

Having the opportunity to discuss parent work with a supervisor, or with colleagues in a work discussion group, is therefore extremely helpful, and this is discussed in chapter 6. To this end, and for processing hitherto unknown aspects of the experience of the session, it is helpful to write up process-recording notes of each session, as often as is possible. This can help to generate new thinking regarding the parents and their relationships with their adolescent child.

The parent worker may also be the case manager for the clinic involved, and he or she will need to balance the different (though linked) responsibilities of each role. In order that the integrity of the young person's treatment framework with his or her therapist can be maintained, and particularly when the parent worker is the case manager, it is most likely that the parent worker will be the primary point of contact with external agencies regarding the young person. This may involve joint work with those agencies, particularly education and social services. (See "Case management, collaborative working, and psychiatric issues" in chapter 3.)

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