ABSTRACT
Family relationships play a significant role in the aetiology and course of psychiatric problems in childhood (Quinton and Rutter, 1984; Garmezy and Masten, 1994). Increasingly, family and carers take part in treatment programmes (Howlin and Rutter, 1987; Russell et al., 1987; Kazdinetal., 1987; Webster-Stratton C., 1991). Ensuring this involvement presents a particular challenge for the staff of in-patient units who will have the care of the child throughout the week but have limited opportunities to meet with family members. The distance of the unit from the family home can be an added complication. This situation may intensify the focus on the child and lead to a marginalisation of other important factors in the child's family relationships and wider environment. It can place the main burden of change on the child whose best efforts may be counteracted by what is happening in ‘life outside the unit’. The admission might also be seen itself as a solution, leading to a decrease in motivation to address family relationship issues (Harbin, 1982). Over time, in-patient units have developed a variety of ways of working with parents and families and many of these will be described in other chapters (see chapters 24–26 and also chapter 32 for strategies in another setting). Work with families will usually include many approaches and a range of professionals but in recent years a number of units have created specific family therapist posts to assist the development of work in this area. Family therapists usually come from a health or social services related profession and have undertaken a specialist four-year training in systemic family therapy. Although their main concern is with assessing families and working with them therapeutically to create change, they are also interested in understanding complex professional systems and the way in which they impact on families. To this end they may meet with whole families, part families, couples, individuals and professional systems as well as thinking about the ways in which work with families is undertaken, in relation both to individual children and the ethos of the whole unit. Some units are able to admit whole or part families during a child's admission and involve them more intensely (Brown, 1991; Didyk et al., 1989). This chapter aims to put forward some guidelines for good practice as well as examining issues that arise when working with families in the context of child in-patient settings. Many of the ideas will have direct relevance to other forms of residential setting.
