Difficulties in the external world of school or college
Engaging in treatment may impact on the young person in a way that leads to difficulties in the external world of school or college. The parent worker, in collaboration with the young person's therapist and parents, needs to be alert to such difficulties. As is usual in good clinical practice, liaison and communication with schools and colleges can be very helpful. One function of this contact is to protect the young person's therapy. There may be instances where the parents ask for the parent worker's help in negotiations or contact with school or college. The parent worker may also attend network meetings as appropriate, particularly when there are concerns that the young person may be at risk.
Dropping out of therapy: implications for parents
In some cases, the young person may drop out of treatment prematurely (as discussed in "Containment failure and drop-out" in chapter 7). When this happens, the parents and parent worker will need to review their work together. They may decide to continue to pursue the work for some further sessions or to bring this to an end. This decision will be made on a case-by-case basis, and will usually require communication within the clinical team. It may be that the work with the parents is seen as having a helpful impact on their understanding of their child's depression, their family dynamics, and their own capacity to tolerate the anxieties associated with their current parenting task. Such continuing work may provide essential emotional containment of parental needs and anxieties and may help them be more receptive, alert, and thoughtful in relation to their child's depression and any risks associated with this. How long this work continues for will also be a case-by-case decision. Remaining within the originally agreed STPP time frame is most helpful, however, with a review at the end of this period to decide if there are sufficient clinical reasons for additional parent-work sessions.
Parents' need for help in their own right
In some instances, the parent worker may assess that the parent is in need of psychological, medical, or social care in his or her own right (an example of this is given in chapter 7). It is the parent worker's responsibility to discuss this with the parent and either suggest how her or she can access such help or make the referral directly on his or her behalf - for instance, to a GP, to psychology services, or to social services. Sometimes, a degree of help may already have been obtained, as with Anna's mother, but the question of additional treatment (such as psychotherapy where none has been offered previously) may become key. This may also become more palatable to the parent as he or she gains some insight into the nature of psychological work through the experience of the parent work.