Creating a space for history taking

Seeing parents wherever possible together, before meeting with the young person, creates a space for the important history taking part of the assessment. It enables us to open up the history not only of the young person from birth, but also the history of the parents. We can make a reasonable assumption that human behaviour particularly when it is repetitive and disturbing as in the case of embedded problems, is never random. It is always connected within a dense interpersonal and familial matrix. For this reason in this initial assessment and formulation process, we make a hypothesis that the young person’s behaviour however unusual, will tend to reflect very precisely the configurations of their own particular family. Not unlike a set of fingerprints, the embedded problem invariably reflects dysfunctional aspects of relational and family life that are specific, personal and characteristic only of that family.

Insight into the history of the young person is very important in helping us to understand how long the problem has been disturbing; whether it is of recent origin or whether the young person has displayed areas of vulnerability from an early age and in primary school. In this, the focus on the developmental task comes very much to the fore. We are also concerned with the parents’ previous experience of childbearing and conception. We may find that there was severe illness in the parents, or a difficulty in conceiving, repeated miscarriages or a stillborn child. All this information constitutes important data about how the young person came into the family and what preceded their arrival. The very fact that there may have been serious difficulties in early or later childhood that were overlooked or denied by the parents, gives us important information about how the parents handle and respond to emotional challenges.

We may also find parents who initially offer a bland thin history of both their child as well as themselves. As we listen to the history, it becomes clear that the problem in the young person before it became embedded could have been attended to earlier, if there had been less denial on the part of one or both parents. In some cases a parent may brush off any concern about their son or daughter by describing their difficult behaviour as just part of their personality. As a result, this may have led them to overlook or put up with challenging behaviour. At other times parents may gloss over the problem by saying that the young person is exactly like themselves, as though this will put an end to the need for any further speculation about the origins of the problem, or indeed any need for help.

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