Prior to therapy taking place a systemic assessment would take place. A contextual risk assessment considers the multi systemic issues surrounding the young person, his/her family circumstances the role of the community and his /her position within the school. The family and key designated educator would be part of this assessment. The assessment will consider the following:
- Are there enough protective factors within the school and family to support and stabilise the young person through the joined systemic therapeutic approach?
- Is the immediate clinical risk too high? Consideration of a supported referral to another service will be addressed if needed to stabilise immediate mental health crisis prior to engagement in therapeutic work. It should be noted that collaborative work with other clinicians offering therapeutic interventions and assessments will take place prior to a reassessment for long term therapeutic relational work takes place.
Pending the outcome of the assessment the following can be offered:
*Referral and signposting to appropriate services for high risk mental health presentation with view to reassessment in the future for long term relational work with the respective appropriate agencies.
*Intensive Family Therapy intervention offered for six months subject to a relational review at three months.
Prior to the relational review at three months the therapeutic intervention would focus on engagement and relationship building and trust. Individual relational sessions are delivered where concurrently individual sessions would take place with the young person, carers and designated educator.
Post assessment where long-term relational therapy has been agreed by all parties concerned, an initial joined contracting session takes place. The aim is to agree and formalise the identified work to be done. The therapeutic task is framed relationally and agreed by the school, family and the young person.
Within the subsequent two months individual sessions with the young person take place therapeutically to build up a therapeutic alliance and trust using the process of strength-based framework. Within the engagement phase the process of intersubjectivity is used to emotionally attune to the young person’s experience of their attachment rupture and their respective relational difficulties. Concurrently individual sessions take place with the respective carers responding to their relational difficulties and exploring possible links to their own historical respective attachment issues which might be having an impact on their parenting relationship.
In consolidating the relational engagement stage individual sessions take place with the assigned educator (attachment agency representative) and the therapist to reflect on the key relational themes. Consideration is subsequently given to the potential therapeutic joining role that the school can play as a protective factor towards the overall therapeutic repair process in preparation for stage 4 Joined Relational Work.
Within the remaining three months ongoing joined therapeutic joined work takes part with all of the system to address the relational task with a view to stabilising the young person. It should be noted that intermittent outreach motivational top up sessions are offered to the young person concurrent to this process by myself to monitor motivation, triggers motivation and emotional vulnerability.
The aim of the joined relational work is to mirror the process of emotional attunement and intersubjectivity therapeutically by fostering the concepts of empathy and curiosity and playfulness. As the educator and respective carers replicate this therapeutic holding framework, consideration is given to the young person’s underlying triggers and emotions which impact of their difficult behaviours. Through the therapeutic process where the young person experiences feeling mentalised and held emotionally in a congruent and consistent manner, then the change process away from relational rupture to repair can start to take place.
In the seventh month of the programme a “Contract of Change Relational Plan” is drawn up between the young person and the school and family, and potential ongoing community resource such as a mentor will be considered to provide ongoing support for the young person to help consolidate the changes to take place long term. All parties contribute to the plan and the designated role they will provide to support the change process for the respective young person. Consideration at this stage of consolidating the emotional repair work with behaviour strategies will be addressed and shared with the respective carers and the school and young person.
A top up of 3 sessions is provided as necessary in terms of support within a three month follow up basis as required prior to the final evaluation taking place.