When dealing with difficult situations such as those in which communication is damaged, when negotiation is difficult or there are false secrets, some pieces of systemic therapy may be useful. The professional should keep in mind that her/his neutrality should be preserved at all cost by challenging everyone or everything while siding with no one. This does not come easily, so take time to think before you speak.
One possible technique is "turn-taking," that is, involving each family member in turn, avoiding questions that invite yes/no responses, checking back with each participant to ask how they see something on which others have commented.
Table 1 Top "Six-Teen" Tips for Dealing with Parents of Adolescents with
1. Gain a good working knowledge of the social history and family dynamics. It is invaluable—never assume anything! (e.g., who is the person the young person talks to most in the family?)
2. Remember to direct your questions to the patient, NOT the parent
3. If conflict is evident, play for time e.g., unscrew pens, flick through notes, etc.
4. Be aware of the adolescent and/or the parent manipulating you
5. Consider the seating arrangement and make sure direct eye contact is possible between you and the young person
6. Remember that adolescents will not always talk openly in front of parents, especially regarding medication
7. Aim for continuity of professionals between visits to help gain the adolescent's confidence—and the parents' as they learn to let go
8. Never stop supporting the parents—even if they are out of the consultation room
9. Plan—start talking about the concept of seeing adolescent independently well in advance, all the time emphasizing the vital role of the supportive parent
10. Be clear about your intention to have time alone with the adolescent
11. Remember the relationship between parent and young person and health professional is dynamic and may vary from visit to visit throughout adolescence
12. Include ALL team members—another colleague can be seeing the parents while you are giving space to the young person. Confidentiality must be assured in all consultations
13. Encourage the parent to sustain the expectation that their child can/will work and live fulfilled and independent lives
14. Encourage the parents to ensure their child's attainment of functional independence, development of autonomy and self-advocacy skills could and should be equivalent to their peers
15. Address any educational/informational needs of the parents as well as the young person and make sure they know of resources available in the community. This means you have to know what there is to offer
16. Don't forget the dads, who may not be present in clinic
Circular questioning may also be helpful as used in family therapy. For example, if we want to see clearly what the definition of the problem is for each family member, we may ask: "What do you think X will say is the problem?... Who agrees with him? ... Who disagrees? How would you put it?" Then, "In what way is this problem a problem? . . . What makes the problem a problem? ... How is it a problem for you? ... Who is it most a problem for?"
Problem-solving can also promote resilience. By asking each party "If you could change one thing ..." negotiation can be facilitated. Ideally the adolescent/family create the solutions but if not, the health care provider can propose one for discussion!!
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