Fam Proc 37:201-213, 1998

Reflections on Ways to Create a Safe Therapeutic Culture for Children

in Family Therapy
PETER ROBER, M.A. Psych
Although a large number of publications in the family therapy field stress the
importance of children in family therapy, some authors report that, in practice,
many family therapists do not actively involve children in their therapies. In this
article, I reflect on the experiential reasons for this exclusion of children. I will
consider the importance of the use of the self of the therapist and of the
creation of a safe therapeutic culture for the child. Practical suggestions are
made of ways to involve children in family therapy. Finally, these ideas are
illustrated in a case example of a family therapy with an adoptive family.
Many publications in the family therapy literature emphasize the importance of
children for the therapeutic process (among others: Ackerman, 1970; Andolfi,
1979; Andolfi, Angelo, & De Nichilo, 1989; Ariel, 1992; Byng-Hall, 1980, 1995;
Combrinck-Graham, 1986, 1989; Freeman, Epston, & Lobovits, 1997; Gil, 1994;
Larner, 1996; Minuchin, 1974; Minuchin & Fishman, 1981; Smith & Nylund,
1997; Tilmans-Ostyn, 1981; Tilmans-Ostyn & Van Caloen, 1984; Wachtel, 1994;
Zilbach, 1986). Notwithstanding all these publications, some authors note that,
in practice, children often are excluded from participation in family therapy
(Carr, 1994; Chasin & White, 1989; Zilbach, 1986). Furthermore, Korner and
Brown (1990) discovered that, in the U.S., 40% of family therapists never
include children in their therapies, and that 31% of family therapists invited
children to the session without really including them in the therapy. It seems
that a lot of family therapists work mainly with couples or individuals.
Some authors (for example, Andolfi, 1979; Chasin & White, 1989; Wachtel,
1994; Zilbach, 1986) state that therapists may have experiential reasons for
excluding children from family therapy. Although there are nonverbal, actionoriented techniques at their disposal, some family therapists are not at ease
with these techniques. Too often, family therapists play it safe by choosing
verbal modesof communication. They don't risk using less predictable or less
easily controllable methods of interaction, especially with children, who are
even less predictable or controllable than adults. Other experiential stumbling
blocks to working with children are the personal responses of therapists due to
their own experiences in childhood. As Zilbach (1986) states: "The family
therapist's decision to see the parents and not children can be a deliberate act
of omission with a particular, therapeutic goal, ... but usually exclusion occurs
by default, inattention or other unrecognized attitudes on the part of the
therapist" (p. 20). Unrecognized attitudes can lead to overprotection of the

child, denial, avoidance, and so on. They can also lead to the exclusion of the
child from active participation in family therapy.
These are just some of the experiential reasons family therapists have for not
including children in family therapy. Undoubtedly, experiential training and
supervision are essential for family therapists who want to include children in
therapy. Thorough reflection on one's own anxieties, hesitations, and
vulnerability is of course important for all family therapists, but it is especially
important for the therapist who doesn't feel at ease in working with children in
family therapy. Furthermore, it is necessary to reflect on the specificity of
working with children in family therapy (among others, see Tilmans-Ostyn &
Van Caloen, 1984; Wachtel, 1994; Zilbach, 1986), and that is exactly the
central aim of this article. I will examine the difficulty of mobilizing the active
participation of children in family therapy; develop some ideas about how the
therapist can contribute to a more active involvement of children in family
therapy; and consider the importance of the use of the self of the therapist.
Throughout the article, I will stress the necessity of creating a safe therapeutic
culture for the child.
The Culture Of Therapy
When a family comes for therapy, they tell a story1 (White & Epston, 1990),
and a story is a selection of things told, and other things left untold. Every story
highlights some things and leaves other things in obscurity. This selectivity
depends on the culture of the therapy.2
As Par (1996) proposed, therapy can be seen as a meeting of cultures.3 When
the therapist and the family come together, they bring their culture with them:
their religion, their education, their gender, their stories, their habits, and so
on. In the therapeutic meeting, a new culture is formed out of the blending of
the two different cultures. This culture of therapy is also influenced by the
referral context, the client's previous experiences with therapy, the client's
experience of the first phone call, what has been said in the conversation up
until that moment, whatthe therapist considers as his or her role, and so forth.
For example: A mother comes for a first consultation with her 9-year-old child
who has serious behavior problems. The therapist asks the mother many
questions about the child and about the child's development; he seems to be
concerned only about an accurate diagnosis of the child.
The culture of this therapeutic conversation is so strongly influenced by the
therapist's urge to diagnose, that the mother cannot speak about her own fears
and guilty feelings. Stories about the feelings of mother cannot be told within
this culture. The feelings of mother remain part of what Anderson and
Goolishian (1988) called, the "not-yet-said" (p. 381).

Another example: A family with a 10-year-old boy called Bart was referred by
their G.P. A large sum of money had been stolen from the mother's purse, and
the parents suspected Bart had taken it. In the session, the boy was very
evasive and silent. He looked tense and suspicious. When the therapist asked
why the doctor had send them for therapy, father said: "The doctor told us we
had to go to you because you, as a family therapist, would know tricks to make
Bart confess."
In this culture of therapy, only stories about blame, denial, and suspicion can
be told. It was only after the therapist made clear that he didn't have any
special tricks, and the only thing he did was talk with families, to seek ways to
help them, that the boy relaxed and talked more freely.
The culture of therapy should make a space for the "not-yet-said," in other
words, for the stories that haven't yet been told (Anderson & Goolishian, 1988).
This culture should open space for as many stories as possible, even if they
contradict each other (Gergen & Kaye, 1992). If we as family therapists want to
make such a space, we must create a safe context for therapy (Anderson &
Goolishian, 1988; Gergen & Kaye, 1992) or, as I call it in this article, a safe
therapeutic culture. It should be a culture where there is respect and empathic
recognition for the stories clients tell. If a client does not feel reassured that his
or her story will be met with respect and empathy by the therapist, it is very
unlikely the client will tell that particular story. Possibly, he or she will omit
important parts of the story, or select another story altogethera story that, in
the given context, is not as vulnerable as the other one.
A Therapeutic Culture for Children
Sometimes it is said that children are spontaneous and open, and that they like
nothing more than revealing what they think, what they feel, and what they
want. In my opinion, that's wrong. Nobody can be as silent as a child,
regardless of how much noise he or she makes. Children can be very covert,
and children have cause to be covert because the world is a complex place to
live in and you never know how grownups will react to things you say or do. So,
it is better for the child to be cautious and not to reveal what he or she feels or
really thinks is important.
How can we as family therapists create a culture where it is safe for children to
say things that haven't been said yet or to show things that haven't been
shown? How can we create a culture where a child is welcome as a child (and
not as a small-sized adult), where children can feel that they will not be
punished, ridiculed, or blamed for things they say or do; a culture where there
is space for both the child's capacities and deficiencies? If a family therapist
doesn't succeed in creating a safe culture for the child in therapy, he or she will

be confronted with a child, silentor noisy, who doesn't really participate in

family therapy.
Let's start with an example:
A family with three children enters the family therapist's room for the first time.
Everyone takes a seat, except the 5-year-old girl. She takes a doll from under
the little table and gives it to the therapist. In a friendly manner, the therapist
asks the child: "Why do you give me this doll?" The child doesn't answer, and
goes back to her mother. For the rest of the session she says nothing and she
doesn't leave her mothers side.
It is obvious that the therapist in this example made a major mistake. His
"why" question clearly doesn't help to create a safe therapeutic culture for
children. Indeed, the question seems to imply: "In this therapy, you have to
explain everything you do in a rational way. You have to give reasons." The
child took the hint and retreated, as if she wanted to say: "This is not a safe
place for children. I'd better stay close to my mother." The therapist could have
said, "Oh, thank you very much. I will take good care of that doll." Such a
response would help to create a safe culture for the child because the meaning
the therapist evokes is: "When you give me something that is precious, I thank
you, and I promise to take good care of it."
Use of Self and Negotiation of Meaning
The creation of a therapeutic culture can be described as a process of
negotiation of meaning in therapy (Gergen & Kaye, 1992). The therapist gives a
certain meaning to something that happens in therapy (for instance, the child
gives the doll) and the client (the child) accepts this meaning or not. If we
describe this process from the perspective of the therapist, we can distinguish
three stages in the internal conversation of the therapist:
1. The first stage, the stage of the inspiration, is mainly intuitive. The therapist
uses his self4 (Andolfi & Angelo, 1988; Fine & Turner, 1991; Haber, 1990, 1994;
Real, 1990) to seek a constructive way to create a safe culture. The use of the
self means that the therapist engages in an internal conversation about the
potential meanings at play in the therapy. He has to give an indication to the
child that the situation has some significant meaning to him or her, in such a
way that the culture of the therapy becomes safer and opener to a greater
variety of stories. In that process of reflection he uses his observations, his
intuition, his affective responses, and personal images. This stage asks for a lot
of creativity and inspiration from the therapist.
2. In the second stage, the stage of courage, the therapist proposes his
response to the family, a response that attempts to contribute to a safe culture.
In other words, the therapist translates his inspiration into action. This takes

courage because there is a risk in responding intuitively in a situation where

one cannot be sure about the meaning.
3. In the third stage, the stage of observation, therapist observes how the
clients respond to the proposed meaning. If they accept the proposed meaning
as one that creates a sense of more safety, then the therapy can proceed. If
they don't feel more safe with the proposed meaning, the therapist can choose
to search for other meanings that may create a safer culture.
Another example may clarify this process of negotiation of meaning:
A mother and a 5-year-old daughter came for therapy after it was discovered
that father had sexually abused the girl. He had not only abused her; he had
also "rented" her out to other people, and had videotaped the sexual activities
in order to sell the tape. The father had been imprisoned and mother now
wanted therapy for herself and her daughter.

In the beginning of the first session, I told the girl that I wanted to get to know
her and her mother: "First, I want to get to know you, so I can better help you.
We will talk and make drawings and play games." When I mentioned playing
games the girl was startled. I noticed this at once and realized that the words
"playing games" could well have been used by the abusers to describe their
activities to the girl. So I continued by saying: "Here in therapy, we only play
games that you want to play. You don't have to do anything you don't like, and
you will not have to do anything that hurts you or that makes you feel bad."
After I had said these words, the girl visibly relaxed.
In this example, there is a negotiation about the meaning of playing games.
The girl only accepted the idea of playing games in therapy after the therapist
connected these words with the meaning of "safety" and "being in control." But
the negotiation wasn't finished yet. At the end of the session something
important happened:
At the end of the session, the mother, the girl, and I were playing with marbles.
When it was time to end the session, I said to collect the marbles and put them
in the box. The girl took some marbles and put them in her lap. Then she said
playfully to me: "You take these marbles and put them in the box." I was taken
aback because it was clear that I could not collect the marbles from the girl's
lap without touching her genital area. The mother didn't react. She just stared
at the girl and me, and said nothing. I then told the girl in a friendly, but firm
way: "You put these marbles in the box yourself. I cannot take the marbles,
because if I would take them, I would touch the special part of your body ...
that part that nobody should touch, because it's yours." The girl did what she
was told and asked me to say more about that special part of the body that

nobody should touch. I explained that that special spot shouldn't be touched by
a strange man. Then the girl said that she had been touched there by her
father and by other men. I said that shouldn't have happened, and that we
would talk about that in the following sessions.
In the beginning of the next session the girl asked me if I could explain again
"about my special part of my body." That was the beginning of the therapeutic
work with the mother and the daughter around the theme of body and
boundaries.
This example illustrates the process of negotiation of meaning in therapy.
Indeed, the therapist, in his internal conversation, wondered if maybe the girl
tried to evaluate the safety in the therapy room. Verbal reassurances of safety
are rarely enough for a severely traumatized child, the therapist reflected.
These children must experience safety in order to feel safe. So the therapist
had proposed a safe boundary to the girl, as if the girl had intended to test the
safety of the therapeutic context. The girl accepted his proposed meaning by
telling the therapist that she had been touched there and by asking the
therapist in the following session to explain again about the "special part of her
body."
It is important to emphasize that we still don't know why the girl had put the
marbles in her lap and why she had asked the therapist to take them. For all we
know, she just wanted to play, or she wanted to show something to her mother,
or whatever. We just don't know. But the therapist and the girl together created
a meaning that contributed to a safe culture for therapy.
TOWARD A SAFE THERAPEUTIC CULTURE
The creation of a safe therapeutic culture for children can be very complex and
difficult. Time and time again the therapist has to react fast in situations that
merit more time and reflection. Often there isn't enough time to think things
over and, consequently, the decisions are mostly intuitive. Another reason why
thecreation of a safe therapeutic culture is difficult is that the therapist cannot
control the culture. The culture is subject to many different factors that the
therapist doesn't even know about. It would be an illusion to think that any
therapist could alone create a safe therapeutic culture. He or she can merely
contribute to it.
Over the years I formulated a few general guidelines about the contribution the
therapist can make to the creation of a safe therapeutic context for children.
These guidelines proved to be very useful in my practice as a family therapist.5
Be Prepared

Family therapists who want to work with children should prepare themselves for
hard work. On the one hand, they must be able to tolerate uncertainty, chaos,
and confusion. They must be aware that they won't be able to control or
understand everything in the session. Unexpected things are bound to happen.
On the other hand, working with children is hardly ever boring and it can
sometimes be very rewarding and stimulating.
In order to contribute to a therapeutic culture in which children feel safe, it is
important that the consultation room is child-friendly. In the practical
arrangement of the consultation room, it must be clear to the child that he or
she is welcome. No expensive designer furniture, no breakable vases, no
vulnerable wooden floor, no high-tech video apparatus. There should be toys,
crayons, fingerpaint, large pieces of paper, and so on. This material should not
be dumped in the corner of the room, nor neatly arranged in a closed
cupboard. It should lie in the middle of the room, well in sight, and within reach
of everyone.
A Good Start
It is important that the child understands from the beginning what is
happening, what is the purpose of therapy, and what is expected from him or
her. At the beginning of the first session the child must be given a simple and
concrete explanation of what therapy is, who the therapist is, and what is
expected from the child. Usually it is best that the parents explain these things.
If necessary, the therapist can help them find the right way to say it.
At the beginning of the first session, it is usually best to get to know the child
apart from the problem (Freeman, Epston, & Lobovitz, 1997). If the therapist
starts the therapy by asking the parents the classical question "What brings
you to therapy?", the parents often start telling their problem-saturated story
wherein they describe how bad, or sick, or crazy their child is. This can create a
culture of therapy were there is only room for stories of blame, pathology, or
insanity, and there's a good chance that the child will behave like a bad, or a
sick, or a crazy childor just tune out and be immobile and silent. To avoid this,
it is often better first to engage the child and the parents in a positive story
about the child. It doesn't have to be more than a short good-humored
conversation about a good experience of the child, or about something he or
she is good at, or about something he or she loves to do, and so on. In this
way, the child knows that the therapist is also interested in the positive sides of
the child and that therapy is a place where there is an appreciation for good
things. After the therapist has devoted attention to this positive story of the
child, he can then make room for the worries of the parents.
Communication and Play

The family therapist has to adapt to the world of the child. In the first place,
this means to be aware of the child's developmental stage. One can't expect a
child to stand on his or her toes trying to reach adult standards. Even if the
children tried their very best, they would still fail to adapt fully to the world of
the adults. So it is better that the family therapist adapts to the child. For
instance, in communicating: the therapist has to use clear and concrete
language, not too many words, and short sentences; to be active in therapy
and give concrete form to words by using objects, images, or behavior; to be
watchful for nonverbal and metaphorical communication from the child, and to
invite the child to use this kind of communication. For instance, the therapist
can ask children, as well as their parents, at the end of the first session, to
bring an object to the next session that can help the therapist to understand
who they are. Some children bring a drawing, others bring a toy or a
photograph or an audio-cassette with their favorite music. Usually these
objects open space to tell stories that haven't yet been told.
For example: Lilly was 10 years old. She was an only child of parents who were
very busy with their professional careers. The parents came with her to therapy
because Lilly was depressed and didn't want to go to school anymore. Every
morning there was a quarrel about going to school, which was very difficult for
mother because she had to hurry to get to work on time.
When I asked Lilly to bring an object that would help me understand her, she
brought a key and a doll named Elisabeth. I asked her to tell me about the key,
but she said she couldn't explain because she didn't want to hurt her parents.
The parents said nothing, but they seemed surprised. About the doll Elisabeth,
Lilly told me that she loved the doll very much and that she cared for her: "I
talk with her when she is lonely and I caress her when she is sad."
The next session Lilly would use exactly the same words to describe how she
often felt at home: "I feel lonely and sad," she said tearfully. I asked her to tell
me more about that. Then she showed me the key she had brought the
previous session and she said sobbing: "I guess I'm a typical latchkey kid, as
they call them on TV."
Play is of course very important in working with children. Play isn't viewed only
as a psychodynamic phenomenon that has a deeper, hidden meaning that has
to be interpreted; rather, it is first and foremost a terrain of interaction and "an
effective tool for connecting the world of the adults, which is rich in abstract
thought and words, with the world of the children, full of nonverbal expressions
and concrete images" (Andolfi et al., 1989, p. 65). In other words, play is more
than a means for understanding. It is the terrain where child and adults meet. It
is interaction and connection, and, of course, fun.

Therapists should consider the things the child brings to therapy as meaningful,
even if they don't understand the meaning of them. Too often we feel
uncomfortable with things we don't really understand, so we dismiss them as
meaningless or useless. Therapists don't have to understand the meaning of all
the things the child does. Often such therapeutic "understanding" is an attempt
to gain cognitive control of the session, or to find a solution for one's own
uneasiness and confusion. Therapists sometimes try to translate all analogical
communication of the child into more controllable, digital communication,
thereby forgetting that the confusion they feel may be part of the story the
child is trying to tell. It usually is better not to understand too quickly
(Anderson & Goolishian, 1988), but just to play with the things children bring to
therapy. Eventually, understanding may come.
Siblings
The presence of siblings in the family session is important for the creation of a
safe therapeutic culture. Siblings take away some of the pressure on the
identified patient. Siblings sometimes prove to be even more unhappy than the
patient; at other times, siblings are a rich source of information. The
interactions between the siblings, for instance, often reflect metaphorically the
relationship between the parents (Tilmans-Ostyn & Van Caloen, 1984). Talking
about the interaction between the siblings can open space for stories about the
relationship between the parents.
For example: Jerry was a 9-year-old boy. His parents worried about him because
he kept very much to himself. He didn't go out to play with his friends. He was
very frightened of everything, spiders, cars, dogs, school... In the first session, I
asked everybody in the family to make a drawing of the family. Then I
instructed each of them to introduce the family they had drawn. Jerry's brother
Frank had drawn Jerry weeping. He had drawn himself consoling Jerry. Frank
said that he tried to reassure his brother whenever he was afraid. I looked at
the parents and I saw mother looking puzzled. Then I saw that mother had also
drawn a person who seemed to be weeping and a consoling person. I asked
mother about it. She said she had drawn father who was depressed, and
herself who tried to lift him up. She then told me that father was obsessed by
the pollution of the environment and that he was very depressed sometimes
when he read about acid rain or about some environmental disaster. She
always tried to console him, but she didn't think she succeeded very well.
It is, however, important not to switch too soon from a focus on the child to a
focus on the marital relationship, because this could be disrespectful toward
the style and tempo of the family. Family therapists who don't feel at ease in
working with children could feel especially tempted to switch to the marital
problems too soon (Tilmans-Ostyn & Van Caloen, 1984).

Parents
Perhaps the most important thing for the therapist who wants to contribute to a
safe therapeutic culture is to have a good working relationship with the
parents. The therapist should avoid getting in a fight or an escalating power
struggle with parents. Parents should always be recognized as the parents.
They should feel respected instead of criticized (Byng-Hall, 1995; TilmansOstyn, 1995). It is advisable to start from the assumption that parents want the
best for their children. Of course, some parents don't want the best for their
children, but most do.
The therapist should respect the parents and listen to what they have to say.
The therapist is the expert of the therapeutic process, but the parents are the
experts of their children. They know their children best. A therapist should not
start to point out the educational or emotional shortcomings of parents,
especially not at the beginning of therapy when a safe therapeutic culture has
still to be created. All too often therapists harbour the fantasy that they could
be better parents than the real parents. One way to point out to parents how
incompetent they are is for the therapist to demonstrate skill and charm in
engaging their child, or by demonstrating how pleasantly he or she can play
with the child, or by showing them how easy it is to understand the child.
Parents who come to therapy with their child feel bad enough as it is. In their
problem-saturated story, most parents are fixated on the things they might
have done wrong in their handling of their child. They feel guilty and impotent,
and they don't need a therapist to rub it in even deeper. They need a therapist
who is prepared to join them in their feeling of failure, disappointment, or guilt.
When the parents feel that thetherapist has accepted these feelings, the
therapist can connect with feelings of competence and mastery.
Words and Interpretations
It is important to be careful when making interpretations about the so-called
real meaning behind the manifest phenomenon. Interpretations can unmask
painful things before the child and the family are ready for them. If a child in
his or her play uncovers a painful theme or a family secret, the therapist has to
be respectful and cautious with that theme or secret and not put the child on
the spot because the child could feel guilty for betraying the family. When the
therapist and the family create meaning together, it is easier to respect the
tempo and vulnerability of the family.
At the same time, it often is crucial to name or give words to themes (for
instance, grief, agression, sexual abuse) that are clearly present in the family,
but that are not named. Indeed, therapy is giving words to things that have not
yet been said in the family. Sometimes the therapist has to name these things
because they are too scary, embarrassing, sad, or painful for the family to

name them. By naming these themes, the therapist shows that she or he is not
afraid to talk about them, and it is also an invitation for family members to
speak about them.
For example, a family comes in therapy because of obesity of the 12-year-old
daughter. The mother also happens to be very fat, but nobody mentions this, or
even seems to have noticed it. The therapist respectfully has to ask about her
weight as soon as possible. The longer the therapist remains silent, the more
difficult it becomes to speak about it, and the more he or she becomes an
accomplice in the silence of the family.
The therapist must avoid using pathologizing labels. When possible, he must
relabel the things being said in the session in words that highlight the
resources and growth potential of the child. I write "when possible," because I
think it isn't a good idea to get in a fight with the parents over the labels being
used in describing their child. It is my experience that it is important to accept
the parents' descriptions, not to replace them by descriptions the therapist
prefers. The therapist has to accept the descriptions of the parents and try to
really understand them. After accepting them, the therapist can place a more
positive description beside the description of the parents, and see what
happens. In my experience, if parents really feel the therapist understands and
accepts their negative view of their child, they are more than glad to accept
the therapist's more positive and hopeful description.
All this doesn't mean that the therapist is blind to pathology. It means that
even pathology should be described in a way that maximizes the possibilities
for growth and change by emphasizing the meaningfulness and the sanity of
the pathology, and by placing the insanity in the context of the individual
development of the child and the development of the family (the family life
cycle).
For example, a family with a 14-year-old daughter, called Cherry, came in
therapy. Cherry had been hospitalized in a psychiatric hospital after a very
explosive row with her parents. "The psychiatrist of the hospital said I suffered
from an identity crisis," Cherry said, "and that's why he refered me to you." I
asked her what "an identity crisis" meant. She didn't know. "Don't you know
yourself?" the mother asked anxiously. She seemed to doubt my
professionalism. I reassured her I knew what the books and the professors said
it meant, but I didn't know what it meant for Cherry and for them, Cherry's
parents. We started talking about what "identity crisis" meant for them. At the
end of the conversation, I summarized what we had talkedabout: "Now I
understand what it means to you, Cherry. It means that, now you are growing
up, you are confused and you hide inside yourself, because you don't want to
get hurt. And you sometimes don't know who you are or what you want. And
when you fight with your parents, it helps you to know who you are because, in

that way, you can prove to yourself and to them that you are different from
them. And for you, the parents, it means that, although she's no child anymore,
neither is she an adult, and you worry about her and you blame yourself for her
confusion.... Do you think I now understand what 'identity crisis' means to you?
Are there aspects I didn't really understand? If so, can you help me to really
understand?"
The Therapist
The therapist has responsibility of taking charge of the session. She or he is
clear about the rules for conduct in the session, with limits that are consistently
enforced (Combrinck-Graham, 1991).
For example, I have a rule that the toys on top or under the table are the toys
to play with, and the toys on the mantelpiece are the toys to look at. (I have
two beautiful model cars on my mantelpiece, which I like very much.) It is
always interesting to see how the family responds to those rules. Some children
quickly lose interest in the forbidden cars, others keep looking at them, and ask
their mother again and again if they can play with them, often embarrassing
their mothers with their insistence. Some mothers plead with me, "He won't
damage them. Can he please play with them?" But I stand firm because the
rules are clear and they are consistently enforced.
The therapist is a well-trained expert of the therapeutic conversation and the
therapeutic process, with the knowledge, the skill, and the experience to bring
this family therapy to a good end. The therapist has an overview of the
therapy; she or he knows what the goal of this therapy is and has ideas about
what ways should be followed to reach that goal. The integrity of the therapist
is crucial to create a context of trust and safety for the parents and the child.
The therapist is also modest and respectful, open to all the questions the family
members might have about the therapy, and to all the feedback they give.
Therapists must maintain their own integrity vis--vis their teachers, gurus, and
the world-famous master therapists. They shouldn't try to be a Minuchin, a
White, or an Andolfi. As Keeney (1991, p. 5) once wrote: the therapist should
"cultivate a healthy irreverence for all teachers and teachings (including this
one)." The therapist must work with his or her own potentialities and resources.
Too much admiration or enthusiasm for the big examples would make the
therapist lose both courage and inspiration.
A Case Example
This is the story of Robert and his radio interview. Robert was a 6-year-old black
boy. He was adopted 5 years ago by An and Erik, a white Belgian couple who
already had a 2-year-old daughter, Eva. At that time, An and Erik worked for a
humanitarian organization in Rwanda. One day they went to an institution for

deserted children, and they saw a very small baby. The nun told them that the
baby was 11 months old and that it had been brought in 3 weeks previously. He
had refused to eat since then. He was in bad shape: "The baby will die within a
week," the nun had said.
An and Erik asked the nun where the mother was. Then the nun told them a
horrible story about a poor young woman who worked as a cleaning woman in
the house of a rich white family. She was happy to have this job because, for
one thing, it kept her alive and out of prostitution.
Then one day the woman got pregnant. When she told her employers, they
were very understanding. They told the womanthat she could keep her job, and
bring her baby with her so that she could take care of it while cleaning the
house. The white people were understanding because they said they could not
have children themselves and they would be happy to have a baby around the
house. A few months later, the baby was born, and the young woman was
happy because she was blessed with a son. She named him Robert. A few
weeks after the boy was born, she was back at work again in the house of the
rich white people. Then a few months later the young mother found out she
was pregnant again. This time the white people were not so understanding:
"One child is company; two is too much," they said. They suggested that the
woman should have an abortion. The young woman didn't want that, though
she understood she had to choose between her unborn child and her job. She
also understood that if she did lose her job, only prostitution would keep her,
Robert, and her unborn child from starving. That's when she decided to keep
her unborn child and to take Robert to the nuns, and ask them to feed him, to
take good care of him, and, if possible, to find a good home for him in Europe
or America. "We accepted the child but now he misses his mother and he
doesn't want to eat anymore," the nun said.
A week later An and Erik adopted the child and a month later they were back in
Belgium. They decided to stay and began a new life. Little by little Robert
started eating again. Robert was saved and everybody was happy.
When Robert was 6, An and Erik brought him to me because they were worried.
Sometimes Robert had bad temper tantrums. He refused to eat and talk, and
he threw his toys around the room. Sometimes he even banged his head
against a stone wall. Afterwards he sat there bleeding and crying. He told his
mother that he "was in his angry" and that he couldn't get out. An and Erik felt
helpless.
I saw the parents, Eva and Robert a few times, and we talked. They were a nice
family. The parents were warm, intelligent, feeling people; the children were
open and bright. The sessions were fun. Although I didn't know what Robert's
symptom really meant, I wondered if Robert had some primitive fear of again

losing his parents, just as he had lost his mother in Rwanda. In his new family
everything seemed to go well, but maybe some dissociated fear and anger
surfaced when it was triggered by something the parents did.6
In the third session, I shared my reflections with the family, and proposed that
we play together. Robert and I would be a radio crew that would interview his
parents and his sister for some future broadcast. We would tape the interview
on an audio cassette. Robert liked the idea. I said that he would be the
interviewer and I would be the technician who took care of the recording. First
we would rehearse the interview. I went with Robert to another room and we
talked about what questions he would ask his parents and his sister.
The Interview
Ten minutes later we rejoined the family and Robert began the interview. He
pointed the microphone at his mother's nose and asked her: "Will you always
take care of me?" Mother smiled and answered: "Yes, I will." Then Robert asked
her: "Will you never leave me?" "I will never never leave you," mother
answered. I could hear tears in her voice.
"Will you always love me?" he asked his father, and then his mother, and then
his sister. They all answered "Yes." "Will we always stay together?" Robert
asked hisparents. "We will," they answered in unison.
At that moment, Robert looked at me with a question in his eyes. "Peter?"
"What is it, Robert?" I asked him. "Can I ask a question that we didn't
rehearse?" Robert asked. Puzzled, I said: "Of course."
After some hesitation, Robert asked his father: "Will we always have much
money?" Father laughed, looked at An, and said: "Even when we're talking
about love and happiness, modern children are so materialistic." He grinned at
his wife. Then he answered the boy: "Yes, we will always have much money."
Robert asked "Are you sure?" "Yes, we're sure," his mother said.
At first I wondered why Robert would ask a question about money. Now I think I
understand. In his life, Robert had learned that love and care depended on
money. He had lost his mother in Rwanda, not because she didn't love him, but
because she was poor. Maybe he was thinking that if she had had "much
money," she wouldn't have deserted him. Probably Robert could not explain
this in words. Still he managed to ask his parents if they would always have
"much money." Somehow he must have felt that it was safe enough in the
session to ask this important question. He hadn't mentioned the money
question while we were rehearsing. Probably the answers of his parents to his
first questions made the culture of therapy safe enough for him to ask this
question in the session.

After the interview was finished I gave Robert the cassette of his interview and I
told him that whenever he was afraid that his parents would leave him, he
could listen to this interview and he would be reassured. Robert looked happy.
Somehow he also looked taller, as if he had physically grown during the
interview. I too was happy with the session. I had enjoyed it and I knew it was a
good session. I knew we had touched on something important that would prove
to be very meaningful for everybody in the family.
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