 The Association for Family Therapy 2000.

Published by Blackwell Publishers, 108 Cowley

Road, Oxford OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.
Journal of Family Therapy (2000) 22: 324–341
0163–4445

Children’s and adolescents’ views on family therapy

Lisa Strickland-Clark,a David Campbellb and Rudi

Dallosc

Family therapy has made a considerable contribution to our understand-

ing of the experiences of children and families and especially how various
symptoms can be understood as their response to distressing family dynam-
ics. Though family therapy has found ways of alleviating children’s distress
we still know relatively little about how children experience the process of
family therapy. Such knowledge is important for ethical as well as prag-
matic reasons – to be able to offer a more sensitive and effective experi-
ence. This paper reports a study employing qualitative methods whereby
children were interviewed about their experience of family therapy. Semi-
structured interviews were conducted after family therapy sessions, and
children were invited to recall what they perceived to be helpful and
unhelpful. Helpful events or moments were then identified and replayed
on the videotape of the sessions to assist children’s memory. The results
suggest a diversity of experiences according to the children’s ages, gender
and role in the family. Some common assumptions were challenged by the
findings, for example, that some children preferred more directive and
focused aspects of the therapy, rather than systemic questions which could
inspire feelings of confusion and inadequacy.

Introduction

I felt pleased that he [father] could understand ‘cos I never thought he’d
ever understand what it’s like, but he’s starting to listen and under-
stand and that’s good.

In the field of family therapy an initial impetus for its development

was the recognition that children’s experiences, especially various
forms of disturbance, were related to their family situation.
Although family therapists developed many ways of engaging and

a Psychology Services, Church Lane, Heavitree, Exeter, Devon EX2 5SH, UK.
b The Tavistock Centre, London, UK.
c Orchard Lodge, Taunton, UK.

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 Children’s views on family therapy 325
connecting with children, there has been surprisingly little research
describing the children’s experience of family therapy or how ther-
apists achieve a therapeutic relationship or sense of connection
with children. The fact that family therapy has evolved without
reference to children’s views or perceptions of the process of receiv-
ing therapy is symptomatic of the manner in which childhood and
children have been perceived historically and highlights an inter-
esting paradox. One of the aims of family therapy is to reduce the
focus on the child as ‘the problem’ and to encourage the child’s
perspective to be heard within the family therapy setting. However,
family therapy studies have largely, with a few exceptions (see e.g.
Dare and Lindsey, 1979), failed to consider the child’s world, how
that child sees the process, what the child understands by it and
whether the child feels validated by it. Other authors (e.g. Mayall,
1996) have emphasized the importance of addressing children
directly in research and have discussed the manner in which tradi-
tional research has focused on the role of the child as object rather
than the collaborator in research.

Previous studies
Only a few studies have sought to elicit whether children find family
therapy helpful (e.g. Marshal et al., 1989) and fewer to date have
explored children’s perception of the processes occurring within the
therapy room. The extent to which children participate in family
therapy sessions has been investigated. Some studies have found
that children speak far less than parents (see e.g. Friedlander et al.,
1985; Mas et al., 1985). The adolescents in Mas et al.’s (1985) study
tended to express themselves in terms of agreement or disagree-
ment. Postner et al. (1971) found that overall, therapists spoke
significantly more often to parents than to children. Cederborg
(1997) argued that the manner in which the parents and the ther-
apist related to the children placed them as subjects acting with
regard to the child. The child then effectively became a non-person
in terms of the status held within the session. She expressed
concern about the implications of this in terms of the potential
impact on the self-esteem of children who are symptom bearers.
Newfield et al. (1990) carried out an ethnographic study of families
whose involvement in therapy was the result of adolescent drug
abuse. The authors stated that some interviewees mentioned how
few adolescents feel free to talk while their parents are present.

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326 Lisa Strickland-Clark et al.
Parents were sensitive to the fact that adolescents had secrets, but
also valued the opportunity for more open discussion than they had
been able to have previously.
Dare and Lindsey (1979) also raised questions about children’s
participation in family therapy sessions. They stated that their clini-
cal experience had indicated that family therapy could become
marital therapy in the presence of the children. Neither of the
above studies elicited the views of children themselves.
One study which has sought children’s views was carried out by
Stith et al. (1996). They interviewed children between the ages of 5
and 13. The authors found one theme, which emerged repeatedly,
was that of ‘being included in the therapy’. Inclusion had two
dimensions: one of being physically present in the room, the other
being involved in what was going on. A theme, which appeared less
important for children than for parents, was the importance of the
therapist’s personality. Overall, the authors found that children
wished to be included in therapy in a meaningful way.

The study
The aim of the study was to explore the nature of children’s expe-
rience of being in family therapy. We decided to interview children
directly following therapy sessions in order to explore their experi-
ences. We were guided in our approach by the work of Llewelyn
(1988) who has suggested that therapy can be usefully analysed in
terms of people’s experiences of helpful versus unhelpful events.
Once identified, significant aspects of these can be explored in
further detail in a collaborative way by means of the Comprehensive
Process Analysis (CPA) (Elliott and Shapiro, 1992).

Participants
Families attending two family therapy clinics in the south of
England were approached. Children between the ages of 11 and 17,
identified as the index patient (IP), with a range of presenting prob-
lems, were selected. Therapists were asked to approach families and
ask them to participate. Gathering a sample was problematic.
Although ethical approval was gained, some therapists expressed
concern about taking children out of their families – post-session –
for the interview. They expressed concern that this would disrupt
the therapy and/or unsettle or pathologize the referred child.

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 Children’s views on family therapy 327
Although this concern was predicted before the research began, the
extent of the difficulty in gaining support from therapists was not
predicted. The process indicated that children were not distressed
by the interview, and seemed generally interested and pleased to be
asked their opinion, indicating that the anxiety lay with the ther-
apists in this respect. As the numbers were small (five children in all),
it is important to note that while the findings of the present research
are interesting, and some common themes emerged, the study
aimed to present a phenomenological description of children’s expe-
riences, and the findings presented here cannot be generalized to
the larger population. The children varied considerably in socio-
economic groups, educational backgrounds and presenting prob-
lems. (NB: The sample included children and adolescents; for the
sake of brevity, all participants are referred to as children.)

Method
Interviews with the children
Children were interviewed without their families on two occasions,
immediately after their family therapy sessions. Time between
sessions ranged from three weeks to two months. The children were
invited to discuss in general how the session had been for them,
what their expectations had been, what they felt about the therapist,
if the session had been helpful and other issues they chose to
mention. In addition, they were asked to try to remember whether
they felt that anything significant – positive or negative – stuck out
as having happened.

Video replay
If the children were able to identify a significant event, this event
was replayed to them using the video of the session. They were
asked to describe how they were feeling and what they were think-
ing during the therapy session. After the final interview, each child
was given a box of chocolates in gratitude for their participation.

Therapist interviews
Children’s therapists were also interviewed. They were shown the
same excerpt from the videotape and asked to describe their

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328 Lisa Strickland-Clark et al.
intentions during this moment of the session. They were also asked
to comment on how they thought the session had been for the
child.
The Helpful Aspects of Therapy Questionnaire (Llewellyn, 1988)
modified for family therapy was used as the basis for the semi-
structured interview. Children were also asked about the least
helpful aspects of the session.

Analysis
We employed a qualitative, inductive approach based upon
grounded theory methodology (Glaser and Strauss, 1968) which
involves repeated readings of the interview transcripts and allows
themes to emerge from the data. By constantly analysing the emerg-
ing themes for similarities and differences, themes are organized
hierarchically into several main categories to incorporate the
principal concepts emerging from the data (Glaser and Strauss,
1968; Henwood and Pidgeon, 1996; Pidgeon and Henwood, 1996).
Significant moments mentioned by the children were further
explored in detail, utilizing a Comprehensive Process Analysis
(CPA). The significant events identified by each child were located
on the videotape and then played back. Each child was then invited,
using a semi-structured format, to discuss these events. Briefly, they
were invited to discuss the events leading up to the significant
moments, the wider context and the impact of these moments in
detail. These two distinct methods were used to analyse the inter-
views; after the initial analysis, areas of overlap were considered. At
the end of the analysis, all the themes to emerge were found to be
subsumed within the following six broad themes.

Results
The main themes to emerge from the children’s interviews were:

Being heard

This category was defined as referring to the notion of being

accepted, and of being included in the family discussions. All the chil-
dren in the study referred to this theme and emphasized the impor-
tance of being listened to. The following excerpts illustrate this.

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 Children’s views on family therapy 329
Ben was aged 11. He was the oldest of three brothers, and had
been referred to therapy as his family was concerned about his
moodiness and the possibility of his inheriting his father’s manic
depression.
Ben: It felt relieving to know that he [father] knew what was. . .[trailed
off ]
R:1 . . . anything else that you felt?
Ben: I felt pleased that he [father] could understand ’cos I never thought
he’d ever understand what it’s like, but he’s starting to listen and
understand and that’s good.
Dan was also aged 11; he had recently started to express extreme
anxiety when separated from his mother. Dan’s parents were
divorced and with new partners, which he found very hard to adjust
to.
R: What was it [therapist] said that made you feel . . .how was it that
it helped to talk about that?
Dan: Um, ’cos he listens to me and understands what I’m talking about
. . .yeah, he just listens to me. . . .

Not feeling heard

This theme refers to the ways in which the children felt that their
reality was not acknowledged in the sessions. In some cases, it
seemed that there was considerable conflict between what the
children were feeling and what they rationally believed to be
happening in the sessions. When they were experiencing strong
emotions, it made it difficult for them to discuss what was
happening to them and heightened their feeling of not being
heard. At these times, it was difficult for them to express them-
selves verbally. Another factor influencing their experience of
being heard/not feeling heard in the sessions was a belief in the
therapist’s expertise, which undermined their ability to express
how they were feeling.
Below, Jane describes her ambivalence about engaging in the
therapeutic process. The wider context here is that Jane has a role
as a rebel in her family and is very identified with her peer group.

1 R = Researcher.

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330 Lisa Strickland-Clark et al.
She refers to the therapists as respectable, implying that she is not. To
engage would mean that she would need to relinquish this role.
Jane: Yeah, ’cos they’re the ones [professionals] who are s’posed to be trying
to help me and they’re the ones who are actually going to be able to do
something and they’re the ones who don’t really give a damn what I
think. . .
R: Right and that’s because they don’t ask you what you think
or. . .yeah?
Jane: Umm, and partly because I won’t tell them what I think.
R: Partly because you won’t tell them what you think?
Jane: Umm, s’pose a bit. . . .
In the two excerpts below, Sue shows the conflict between feeling
that her emotions were not acknowledged or understood in the
session and the rational aspect of her experience, which was her
belief in the therapist’s expertise and good intentions.
R: Do you think the therapist understood how you were feeling at that
time?
Sue: Umm, no. . . I don’. . .well, he passed me a box of tissues [laughing]
so he must’ve known I was upset and stuff but um . . . he probably
thought that I was finding that hard but then he probably wants to
pursue it because he thinks it will be better for me in the end I suppose.
R: Umm, so you felt like he pursued what you were feeling but it made it
hard to listen because you were feeling upset.
Sue: Yeah.
...
Sue: Umm, I dunno, I go in thinking right, I’ll try to concentrate the whole
way through this and be interested and stuff and then I sort of . . .I
think it’s when something’s said that sort of affects me or I feel upset
about I think that from then on it’s really difficult for me to concen-
trate and listen to what anyone else is saying because I’m just sort of
going through in my head all my thoughts and I’m not really paying
attention. . . .
Sue feels unable to continue attending to the session, as her
emotions are so powerful that she is no longer able to listen.
Sue could not identify a helpful moment in that particular
session. She was however able to identify a moment in which she felt
misunderstood and which she described as least helpful. It is a
moment in the therapy where the therapist is drawing her attention

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 Children’s views on family therapy 331
to her positive qualities and is considering why she feels such a failure
in relation to her sisters. The therapist then mentions Sue’s relation-
ship to her father, which is troubled. The therapist asks, ‘If you suddenly
became transformed, and became this very confident person, what would the
implications be for the family?’ For Sue, this is an impossible question; she
cannot see beyond her current way of being. She becomes tearful,
feels that she cannot express herself and begins to withdraw.
Sue: ’Cos he asked like how will this affect the family if I do this and it’s
just like I don’t know how it will affect it and I can’t answer that I
don’t know how it will affect it and he was saying if you change and
be more confident and stuff and I was just thinking well, I’m not I
don’t know how to become more confident and I can’t actually see
myself being like this and so, if I can’t see myself being like this then
how can I see how it will affect my sisters if I was like that. . .I just
can’t see it and . . .no. . .didn’t understand . . .couldn’t answer that
question, I found it really difficult and I find it really difficult to say
I don’t understand that or I can’t answer that, I find that really
difficult ’cos I feel like I should understand this question and so if I
say I don’t understand it, it’s just going to make me look stupid.
For the therapist, Sue’s display of emotion indicates that she has
realized something important. ‘I was quite struck by how thoughtful she
was and my impression was that right at that moment she was quite curious
about the alternative possibility.’ However, for Sue, it was an expression
of her not feeling understood. For Sue, the therapist noticing her
lack of confidence meant ‘I have noticed that you lack confidence,
you should be confident, therefore, this is another way in which you
are lacking and it is apparent to everyone’. For the therapist it
meant ‘you deserve to feel more confident’. This extract was seen
to fall within the general category of ‘not feeling heard’.
In the following extract, Sue expresses the conflict she feels as
she defers to the therapist’s expertise and authority and tries to
remain true to her self and her feelings.
Sue: . . .and sometimes I feel as though umm people sort of put words into
my mind and thoughts into my mind and I think well, if a family
therapist has told me maybe I’m thinking like this then he must be
right because he’s done all this research or he’s done all this work so
he must be right and is that how I’m feeling and I end up asking
loads of questions in my head. . . .‘Is that how I’m feeling. . .or am I
not or’. . .dunno and especially ’cos, he has, there’s different points of

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332 Lisa Strickland-Clark et al.
view from different people, well maybe none of them really do know
how I’m feeling, maybe they’re getting this all wrong.
R: Umm. . .
Sue: Don’t know who to trust really.
R: Right.
Sue: Who to trust with what opinion really.

Coping with challenges

Here, the young people presented the idea that therapy was a chal-
lenge. It was construed as a place of struggle, of solving problems,
facing up to difficulties, or a place where conflict was experienced
in trying to avoid those difficulties. On occasion, therapy repre-
sented a place where they expected judgements to be made. Some
children worried about what was going to be said in the sessions.
For others, therapy served to remind them of painful times in their
families, which they found difficult. Other children, however, saw
the therapy as an opportunity to find solutions to problems.
Dan explains the feelings of apprehension he felt when the ther-
apist asked his mother to explain how she felt about her boyfriend.
He says that it had only been his timidity, which had prevented him
from asking to leave the room. However, he goes on to explain how
the anxiety was alleviated when he heard what his mother had to
say.
R: How much of the time did you feel interested or involved in what was
happening?
Dan: Er. . .all of it really, apart from when he was speaking to my
Mum . . .
R: Uh huh. . .
Dan: I didn’t really want to be there when he talked to my Mum about her
relationship with [boyfriend] because. . .I just don’t like being there
when he talks about different relationships in front of me, so. . .when
he talks to my Mum about things that are not about me then I didn’t
really I didn’t want to be in the room when he was talking about
that. . .
R: Right, what kind of feeling did you have when that was going on,
when you didn’t want to be in the room?
Dan: Um, I didn’t want to hear what she was going to say, ’cos that might
have upset me. . . but it wasn’t that upsetting so. . .I was, at a point,
going to say ‘can I just go out the room while you discuss what you’re

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 Children’s views on family therapy 333
going to say’. . . ’cos I feel quite embarrassed to say things like that in
front of people . . .
R: . . .So it was quite hard to sit and listen to it. . .
Dan: . . .Yeah. . . .
This excerpt illustrates the complexity of the experience of partici-
pating in family therapy for some children. The notion of talking
things through is fraught with difficulties, and listening to others
discussing feelings is a struggle for them. However, it also illustrates
the strong sense of loyalty and resolve that some children feel.
The children also adopted the attitude that facing difficulties
was a positive challenge, and they aimed to find solutions to prob-
lems. Pete was 13 years old, the oldest of three children. He was
referred for some obsessive behaviour and for violent outbursts.
He was very close to his mother and had a very positive attitude
towards the therapy. For him, the time spent in the session is seen
as productive and involved working together to find solutions to
problems.
R: How much of the time did you feel interested and involved in what
people were talking about?
Pete: All the way through.
R: And, what made you feel interested in particular?
Pete: ’Cos I wanted to find, ’cos I didn’t know about the problem that my
Mum mentioned in it, I wanted to find out how we could sort that
problem.

Bringing back memories

Dan talks about how therapy serves as a reminder of painful times
in his family and how his younger brother avoids thinking about
them by not attending the sessions.
Dan: Um, [younger brother] doesn’t like coming ’cos the first time when all
my family came, my Mum, my Dad and [younger brother] [sister]
and me. . .[younger brother] got really upset ’cos. . . he finds it diffi-
cult . . .I’d prefer it if he did come, so it’s not just me speaking to um
[therapist] about my problems. . .but apart from that yeah, I would
like him to come. . .he gets quite upset.
R: Does he. . .? What do you think is upsetting for him?
Dan: He just doesn’t like bringing back memories, because it has been quite
bad arguments. . . .

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334 Lisa Strickland-Clark et al.

Difficulties in saying what you think and feel

In the two excerpts below Sue discusses her response to a session
she found difficult, and shows how she would rather avoid talking
about painful issues. She questions the value of going through the
pain.
R: What was the session like for you?
Sue: Umm, I find it hard talking, I always find sessions hard, talking,
especially when there’s more than one person to speak to, it was easier
than most sessions, I think, but I just, it just upsets me, to hear
things. I’d rather not listen to it really, try and switch myself off.
...
R: . . .did anything important happen for you?
Sue: No, not really, sometimes I see it, especially when the session’s partic-
ularly difficult I find. . . what’s the point in doing this, what’s the
point, sort of. . . walk in feeling OK and then come out I dunno, been
crying and come out worse than I already was and just think, well
there’s no point in keep coming just to start feeling bad again. . . .
Possible reasons for the difficulty some children had in expressing
themselves during the sessions are discussed in the ‘Implications for
therapy’ section of the paper.

Concern about reactions from other family members

Several of the children said they found it difficult to speak out in the
sessions as they were concerned about how their family would react
or had reacted in the past. Some children were worried about
discussing private family matters in public. Other children felt that
a prohibition was placed upon them by other family members, who
did not want issues to be discussed in public. In this instance, the
therapeutic setting was viewed as a place where the family wished to
present in a positive light to the therapist and so children felt their
behaviour was being monitored. Some children had either experi-
enced bad reactions from other family members when they had
spoken in the past, or feared bad reactions from other family
members, and so had decided not to speak any more. They also said
that if they did say what they thought in the sessions, they would be
asked to explain this by their family afterwards. For some of the chil-
dren the therapy was somewhere where they felt under-confident

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 Children’s views on family therapy 335
about speaking. Two of the children mentioned the notion of
having an advocate or absent family member present for support. In
contrast, other children said that they felt able to say exactly what
they wanted in therapy and considered it helpful in enabling them
to be understood by their family.

Bad reactions from other family members. Jane talks about the difficulty
she has in saying what she thinks during the sessions. She describes
how she has come to withdraw because her early experiences of
saying what she thought were not well received.
Jane: I think the first time I came er. . .I was bored, but I did actually talk
then, but the thing was. . . if I’d say something my Mum didn’t like,
my Mum burst into tears and then she wonders why I don’t talk
anymore, ’cos she just starts crying. . . and then I just end up feeling
guilty so I’m not going to talk if she’s going to be like that.

Concern about the consequences of speaking out. She goes on to say that
she does not feel she can speak because it will lead to her being
questioned afterwards by her family.
R: Um. . .so what makes it hard to talk here?
Jane: Because anything I say here, in front of my Mum or [mother’s
boyfriend], as soon as I get outside they’ll start asking me why I said
something like that.
This difficulty in expressing oneself was mentioned by Sue, who
thought that she had a responsibility to keep everyone in the room
happy. Trying to do this with the whole family in the room was expe-
rienced as extremely stressful.
Sue: I think throughout the whole session I feel uncomfortable anyway
. . .yeah, but I s’pose that time I felt particularly uncomfortable.
R: Right.
Sue: I sometimes feel threatened as well because there are a lot of people
around and I’m trying to say the right thing to keep everyone happy
and I don’t like to upset anyone and that’s why I’m always sort of
conscious of what I say and stuff.
R: Umm, so it’s actually quite stressful for you to go in there and worry
about what everybody else is thinking and. . .
Sue: Yeah, yeah.

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336 Lisa Strickland-Clark et al.
This sentiment is reiterated by Dan, who had asked for time
alone with the therapist after this session.
R: . . . and did you feel that you could talk about the things that were
important to you?
Dan: Um yeah. . .when I had this [indicates individual time with therapist
after session] ’cos I sometimes can’t say things in front of my Mum,
cos I don’t like that ’cos she might get offended.

Feeling free to say what you think. In contrast, for Ben, the therapy
room represents a place where he is free to say what he likes; he
does not feel responsible for monitoring his behaviour in order not
to upset other family members. It is interesting to note that the
wider context here is that Ben’s family was self-referred. They
viewed the therapy as somewhere to help them manage family prob-
lems and were very engaged with the therapeutic process.
R: Were there any times during the session when you felt uncomfortable?
Ben: Um, no not really I don’t think, it’s always interesting whenever I
come and I don’t really feel uncomfortable in the sessions because I
can say what I like, there’s not like, restrictions, no, it’s good.

Needing support in the sessions

Several of the children referred to feeling the need for support in
the sessions. Dan explains how he would have found it easier to talk
if he had had the support of his younger brother (who had elected
not to attend) in the sessions.
R: How would it help you if he came?
Dan: So, I’d have someone to stick up and if I couldn’t say something,
he’d be there to say it for me ’cos he’s the kind of person he doesn’t
. . .like today, I wanted to go and ask someone if I could borrow a
video, and I just couldn’t get round to saying it to him, so when he
got round. . . he just went and did it straight away, because he
hasn’t got no problem about it.
R: Right, so it would’ve kind of got your point of view across better
. . .support in a way?
Dan: Yeah.
This was also mentioned by Jane.

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 Children’s views on family therapy 337

The children in therapy

One of the strengths of the research was the manner in which chil-
dren responded to the interview. Our previous experience of
research with children indicated that children respond differently
to an interviewer who has the role of researcher than they do to an
interviewer in the role of therapist. The fact that they were being
asked to give their view on how the process of their therapy should
be managed appeared to be empowering for them, and helped
them to step out of their role as ‘problem’ and into a role in which
they had something to offer. They seemed to respect the notion of
research, and the idea that they were helping therapists in their
work and that this might help other children and families. They
were thoughtful and articulate in their answers and reinforced our
belief in their capacity to reflect upon their experience in a mean-
ingful way. However, in order to understand what was said by the
children, it was important to consider the wider context, i.e. what
was said by the therapists and how their responses affected the chil-
dren’s experience. A number of factors appeared to characterize
the children’s experience of being included. They seemed to
expect to feel judged, and so when it was clear that the therapist was
not judging them they appreciated this. Some also expected to be
reprimanded during the sessions. This led to their viewing the
sessions with apprehension and then with relief when the therapist
viewed them positively rather than negatively. All the children
mentioned the importance of being listened to. For them, this
encompassed being understood and having their viewpoint or
discourse represented to their family by the therapist. When the
therapist explained that the meaning of behaviour for a child can
be very different from the meaning it has for an adult, it served to
help the adults in the family change their view of the children’s
behaviour. It is important to note here that considerable prepara-
tion appeared to be needed before adults could hear the children’s
discourse. Where the therapists positively re-framed the children’s
behaviour, either directly or using the reflecting team technique,
parents seemed to be more able to listen to a non-pathological
description of their behaviour. This positive re-framing seemed to
need revisiting frequently.
Times when children did not feel understood appeared to be
characterized by a number of factors. When therapists suggested
that they behave in a more rational manner than they felt they were

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338 Lisa Strickland-Clark et al.
able, it seemed that insufficient attention was being given to the
children’s feelings in the room. For the children, whose feelings
seemed almost overwhelming at times, this lack of attention meant
that they were unable to listen to what was being said. They
reported finding this experience upsetting and frustrating. Another
factor, which appeared to lead to the children feeling unheard, was
when the therapist attempted to build their confidence by express-
ing concern that they were not confident. It seemed that a more
effective stance was to focus on the child’s strengths, rather than
attempt to explore the reasons for their weaknesses.
The category ‘Difficulties in saying what you think and feel’ indi-
cated the strength of feeling children experienced in the therapy
room, and how, for some, therapy represented a very painful expe-
rience, whereas others welcomed the notion of finding solutions to
problems within the sessions. Consideration of the similarities and
differences between these children indicate that those children who
generally wanted to avoid difficult feelings found the other aspects
of the sessions difficult, and two of the children spoke of wanting to
leave the room. These same children said they found it difficult to
talk in the sessions. Two of the three were adolescents; therefore
Newfield et al.’s (1990) finding, that few adolescents felt free to
speak out in front of their parents, is supported here. However,
there appeared to be complex reasons for this; it related to concern
about upsetting other family members, and to feeling that their
ideas would be rejected by others. It related to a feeling that the
therapy room was separate from the family arena and a concern
about discussing private matters in public. One girl expressed a fear
of getting it wrong. She recognized the therapist’s education and
expertise and did not want to express what she thought for fear of
appearing stupid in front of him. This led her to doubt her feelings,
which resulted in her feeling confused and upset.

Discussion
Some of the young people in the study mentioned that it was diffi-
cult to speak in the therapy room. One hypothesis is that chil-
dren’s reactions were influenced by their attachment style. An
insecure/avoidant style is associated with denial of past pain and an
avoidance of emotional or physical closeness. An insecure/ambiva-
lent attachment style is characterized by over-closeness, enmesh-
ment, and mutual monitoring and blurred boundaries. Byng-Hall

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 Children’s views on family therapy 339
(1995) has considered the way in which children’s and adults’
attachment styles manifest in the therapeutic situation. He says that
while the family is together in the room, dyadic attachment patterns
are still activated. In families where there are insecure attachments,
the dangers of abandonment and alienation come from within the
family, with attendant fears on the part of family members of what
they may do to each other. This means that during the therapy,
family members remain vigilant, leaving their capacity for
autonomous exploration dampened. Byng-Hall (1995) explains
how he considers family therapy to be a means of providing a secure
base for the family from which they can, under the protection of the
therapist, explore core anxieties. This explanation seems to provide
some understanding as to why some of these children found certain
aspects of the sessions so much more difficult than others. In order
to help the child deal with the emotional pain of this situation, the
therapist needs to explain that, to some extent, exposure to painful
or uncomfortable feelings is part of the therapeutic process, and
children need to understand and expect some level of discomfort.
It may also be that children would benefit from having the process
of attending therapy explained to them more fully by the therapist.
Questions which explored the difficulty children had in speaking,
what they thought the consequences of saying the wrong thing
might be and what it meant to not speak, could help the family and
the therapist understand better how they were positioning them-
selves in relation to the therapist.
By conducting a grounded theory analysis with CPA, it was
possible to clarify that ‘being heard’ was a key category for the
children. This is in accordance with much research on client satis-
faction in therapy and with findings by Stith et al. (1996); children
value being listened to and included in therapy. However, factors
affecting the children’s capacity to feel heard in the sessions were
multi-faceted. In this study this appeared to be concerned with
maintaining a sense of self in the sessions, a sense of their identity,
and of being true to their emotions. It also related to the role the
children had in their families. This was true of two of the older
teenage girls, and one of the younger boys. Cederborg (1997)
believed that therapists do not converse with children to any great
extent because of low expectations of their competence as conver-
sational partners. Her findings indicate that young children do
not expect to participate on a more symmetrical basis. This is
tentatively corroborated here insofar as the younger children’s

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340 Lisa Strickland-Clark et al.
interviews did not appear to manifest the struggle for power in the
same way as those of the teenage girls. For the teenage girls, it
seemed that the struggle for power was expressed in an attempt to
refute the therapists’ definition of ‘how things are’; as the girls did
not feel competent to articulate this themselves, their only option
was to withdraw from the session. The sample size of this study
made it impossible to fully evaluate the influence of age and gender
on the children’s responses, however.
Further work in this area could aim to include children’s and
young people’s views in client satisfaction surveys and clinical audit.
This would serve to empower young people and help develop a
more child-centred approach to service provision.

Acknowledgements
We would like to thank the children, families and therapists
involved for giving their time to this research so generously.

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