Single mom, working, raising two or more children. The children have behavioral problems manifested at school which garnered referral for them for services and for the mom to attend counseling to improve parenting and deal with her own issues which often include depression, anxiety and some history of abuse of some kind. This is a common presenting problem in many communities. The referral may be court ordered if the children or family have had violent or abusive episodes. But sometimes our systems of care become one more burden on already burdened families. This mom, and maybe her live-in boyfriend or third husband, is expected to be able to get all of their kids to widely disparate appointment times and varied agencies, meet with the caseworker, hold down a job, transport kids to activities and pay the bills. And if there are glitches in this plan, then the family is “not cooperating” or is “resistant” to the services that well-meaning programs have to offer.
How many agencies offer evening and Saturday appointments? Yes we all have our families too so we don't want to work such hours. How many counseling centers or programs offer any kind of child care so that parents can meet and discuss parenting or marital issues without the added issue of where the kids will be while this happens? I work with many military couples, displaced to our part of the country for training or short rotations, and they do not have extended family or friend networks that most of us rely on for childcare after-hours. Nor do they have the income to pay for a sitter, even if they could find one. When do they come for marital therapy? Miss work and that gets frowned upon. Come late and the kids need dinner and homework help. Who sees folks on the weekend and anyhow that’s full of soccer and grocery shopping and trying to fix the car. Not to mention the kids might be at a different home every other weekend. But clearly they need help and seek it. I have no magic answer here- only a few things that have worked for me.
I do schedule family meetings at times at 6 and 7pm and sometimes I offer to have pizza at the meeting- both to help the family with the need to have dinner and to offer some nurturance and rapport building help (and I keep the receipts and it is a tax deductible office expense for me). It doesn’t cost me much but gains much in focus, attendance and reinforcing the idea that I am there to help- not to create more stress. I also have the luxury of some college counseling interns- and yes, sometimes I ask them to “work with” the children while I meet with parents as their own schedules may accommodate this kind of timing. Having an intern meet with the kids I gain valuable collateral information, the children have a caring adult to interact with and the student gains valuable experience. I think its a safe way to gradually transition a brand-new counselor into independent client work by having them do work with collateral and non-referred parts of the family and work their way into primary therapy.
It even works in reverse when I am seeing a child in art therapy but an intern may meet with the parents (that would just be waiting in the lobby or talking on their cell phone sitting in the car waiting) and offer a sounding board and some parenting resources. One last way I try to accommodate couples that have childcare issues, I allow babies in session up to about a year- as long as the sessions are not so heated or in any way inappropriate. I know even babies are listening and sensing the mood- just as they have at home. I actually like to see a parent or couple deal with their infant; it gives me a window for how they handle the stress and demands or how much they can relax and go with the child's needs etc. And for older kids I do have a kid-friendly area they can wait in- that includes toys, books, art supplies and a safe place for those kids that can be unsupervised.
I’d rather have them at my office than at home alone- which is some parents solution. I’d love to hear other’s thoughts- both as private practitioners and other settings such as schools, community agencies or medical settings. How do you handle the need for family members to be seen, but the competing need for care for the non-client parts of the family…? It seems simple- but it's not- and I for one welcome solutions. None of my ideas and solutions are without pros and cons... but nothing we do is. "Ring the bells that still can ring. Forget your perfect offering. There is a crack in everything - that's how the light gets in." Leonard Cohen
Joan Phillips is a counselor, art therapist, and marriage and family therapist. She maintains a private practice and teaches at the University of Oklahoma.