Michelle O'Reilly

Children's participation and the familial moral order in family therapy

This article examines discourse practices surrounding children’s participation, non-participation, and the ‘moral order’ of the family in the setting of family therapy consultations. The analysis focuses on two central issues. First, the relationship between therapists’ questions, the speaker selection techniques built into those questions, and the responses produced by family members. Second, the relationship between turn-taking and the linguistic features of person deixis in disputes that emerge around children’s orientation to implicit accusations in the talk of other participants about them. The findings reveal how a familial ‘moral order’ is often at the root of how children’s competence as participants is managed by the parents, the therapist, and the children themselves.

Who's a Naughty Boy Then? Accountability, Family Therapy, and the “Naughty” Child

The author explores the concept of the “naughty” child through a language-based approach to examine how it is employed in a family therapy context. Using discursive psychology, 22 hours of family therapy are investigated to examine how children with behavioral/ conduct problems are constructed within this institutional setting. The members of the interaction construct either the child or the behavior as naughty as a way to manage accountability and provide an assessment of the child. It is concluded that the concept manages accountability for the parents and the children. Discussions of implications for labeling and therapy are considered.

Doing mental health research with children and adolescents: A guide to qualitative methods.

Theory and background Theory and Utility of Qualitative Research The Need for Qualitative Evidence Clinical and Research Roles Getting Started Planning a Child Focussed Project Recruitment and Communication The Research Setting Data Collection Questionnaires, Observations and Ethnography Interviews and Focus Groups Naturally-Occuring Data Internet Methods Recording and Transcription Analysis and Writing Up Data Analysis Reflective Practice to Reflexive Research Dissemination

‘We're here to get you sorted’: parental perceptions of the purpose, progression and outcomes of family therapy

This article reports research on family therapy interactions. The research uses discourse analysis to explore the ways in which parents construct their reasons for requiring family therapy, the outcomes they desire from it and orientations to their progress. The analysis suggests that parents often position their child as the problem and this is something that is rarely challenged or questioned by the child. Parents express a desired outcome of ‘fixing’ the child and highlight this as what they believe the purpose of family therapy to be. During therapy they emphasize their progression and consider improvements in family functioning. By understanding parental perceptions we can move research forward in understanding engagement in therapy and attrition, and integrate guidelines on service improvements with what parents feel is beneficial. Practitioner points Parents manage their presence in family therapy in many ways and typically position the child as the reason for their attendance. Offering the child some time alone with the therapist has potential to uncover the childs perspectives on goals and outcomes which may be inhibited by parental presence. Anticipating that the child may be described in derogatory or negative ways at the start can help the therapist to reframe the problem in more helpful ways.

What Can Education Teach Child Mental Health Services? Practitioners' Perceptions of Training and Joint Working.

The importance of joint working between educational and child mental health professionals is well documented but there are numerous challenges and only limited training models. While the evidence base and training programmes for educationalists regarding child mental health is growing, training mental health professionals about education is more limited. This study presents the views of 36 child mental health and education professionals from four service localities in England regarding their experiences of joint working and perceptions of training, including a preliminary evaluation of a training programme designed to bridge this gap. The findings indicate that participants perceived that a degree of knowledge in education matters is important, and reported that this could be acquired through the development of relationships with educational professionals, setting up link posts and joint training; they also described challenges related to building experience and to resource constraints. Participants were generally positive about the training package and reported that there was a clear training need in this area.

Ethics in praxis: Negotiating the presence and functions of a video camera in family therapy

The use of video for research purposes is something that has attracted ethical attention and debate. While the usefulness of video as a mechanism to collect data is widely agreed, the ethical sensitivity and impact of recording equipment is more contentious. In some clinical settings the presence of a camera has a dual role, as a portal to a reflecting team and as a recording device to obtain research data. Using data from one such setting, family therapy sessions, this article shows how the role played by recording equipment is negotiated in the course of talk and other activities that constitute sessions. Analysis reveals that members of the therapy interaction orient in different ways and for different purposes to the value of recordings. The article concludes that there are layers of benefit to be derived from recording of clinical interactions, including for members themselves, and this has wider implications for the ways in which qualitative research designs in health sciences are evaluated.

Diagnosing autistic spectrum disorder in the age of austerity

BACKGROUND Diagnosing autistic spectrum disorder is a challenge, typically involving myriad professionals. In the current climate we explore how diagnosis is managed in the real world by professionals. METHODS Using semi-structured interviews we thematically analyse data from psychiatrists, paediatricians and educational psychologists. RESULTS While there is some consistency across and within these groups there are also a number of variances, and several important issues are highlighted. These include the problem of time and resources, the issue of location for diagnosis, the value of diagnostic tools and schedules, the need for supporting information, the difficulty of multi-agency working, the relevance of a physical examination and the eventual diagnostic label. CONCLUSIONS In the current economic climate and considering changes in guidelines there is a need to evaluate current service provision and enhance services. However, attention needs to be paid to the practical and realistic application of the suggested guidance.

“We Are Alone in the House”: A Case Study Addressing Researcher Safety and Risk

Historically, the safety of research participants has taken precedence in health research. More recently, however, in response to anecdotal reports, there is growing concern for researcher safety, which has resulted in policy development. Also, there is a small body of empirical discussion emerging. In this article, we present a case study example of a particular incident that happened to one of the authors during the course of data collection. We present this as a case study using two sources of data to support the narrative. We utilise extracts from the original interview in which the threat to safety occurred, and this is supplemented by an interview with the transcriptionist who transcribed the threatening interview. Using thematic analysis, we found three key themes from the data: physical threat, emotional responses, and managing risk. Our findings suggest that despite reflectively considering and adhering to valuable protocols relating to risk assessment, unprecedented events may still occur. We recommend, therefore, that research teams develop strategies to manage the implications and impact of research involvement to maintain a healthy research team.

Ongoing processes of managing consent: the empirical ethics of using video-recording in clinical practice and research:

Using video to facilitate data collection has become increasingly common in health research. Using video in research, however, does raise additional ethical concerns. In this paper we utilize family therapy data to provide empirical evidence of how recording equipment is treated. We show that families made a distinction between what was observed through the video by the reflecting team and what was being recorded onto videotape. We show that all parties actively negotiated what should and should not go ‘on the record’, with particular attention to sensitive topics and the responsibility of the therapist. Our findings have important implications for both clinical professionals and researchers using video data. We maintain that informed consent should be an ongoing process and with this in mind we present some arguments pertaining to the current debates in this field of health-care practice.

“This is a question we have to ask everyone”: asking young people about self-harm and suicide

WHAT IS KNOWN ON THE SUBJECT?: An essential part of the mental health assessment is to evaluate the risk of harm to self. Fundamentally this involves asking directly about self-harming behaviour and suicidal thoughts or urges, but practitioners often find it difficult to open up these conversations. This evaluation of risk is particularly important as self-harm and suicidal thoughts are frequently found in young people who attend mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Young people are not always routinely asked directly about self-harm or suicidal thoughts when they are assessed. There are two ways that mental health practitioners introduce this topic: first, by building up to it by initially asking about general feelings, and second by stating that it is a requirement to ask everyone. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These questions should not be avoided by mental health practitioners just because they are difficult. We offer suggestions as to how to ask questions about self-harm and suicide based on real-world practice. ABSTRACT Introduction Questions about self-harm and suicide are essential in risk assessments with children and young people, yet little is known about how mental health practitioners do this. Aim The core aim was to examine how questions about self-harm and suicidal ideation are asked in real-world practice. Method A qualitative design was employed to analyse 28 video-recorded naturally occurring mental health assessments in a child and adolescent mental health service. Data were analysed using conversation analysis (CA). Results In 13 cases young people were asked about self-harm and suicide, but 15 were not. Analysis revealed how practitioners asked these questions. Two main styles were revealed. First was an incremental approach, beginning with inquiries about emotions and behaviours, building to asking about self-harm and suicidal intent. Second was to externalize the question as being required by outside agencies. Discussion The study concluded that the design of risk questions to young people had implications for how open they were to engaging with the practitioner. Implications for practice The study has implications for training and practice for psychiatric nurses and other mental health practitioners in feeling more confident in communicating with young people about self-harm and suicidal ideation.