Working with Children and Young People in private practice

Dr Emilie Cassell has 17 years of experience working with people with emotional and behavioral problems in both NHS and private practice and was a founding member of Surrey Therapy Practice. Today she sat down for an interview to give her thoughts on what therapists should consider when working with CYP (children and young people).

1. How does working with CYP differ from working with adults?

The first main difference is that it involves working with people at different stages of their development. This will impact on the way in which you assess their difficulties and the way in which you approach therapy, as even explaining the concept of therapy to a 7 year old is a different task to explaining it to a 17 year old.

The second is that work with young people almost always must involve the “systems” they are a part of. This typically includes their family, their school and sometimes social services. As a therapist, your contact with these systems can vary from occasional phone calls and/or emails to attending professional meetings. When working in private practice its important to think in advance about how much of this liaison work you are prepared to do so you can be clear about this when you talk to a family for the first time.

These features of working with children and young people make it necessary to have relevant clinical training.

2. What should therapists think about before they start working privately with CYP?

It’s very important to get everything in place legally before working with CYP. You will need an appropriate DBS check and professional indemnity insurance. If you have protected title, you need to ensure you are a current member of the relevant professional body such as the HCPC, BPS and/or BABCP.

It is also important to think about your terms and conditions, including what services you are offering, how much you will charge for them and how your clients can pay you. Bear in mind that insurance companies will not usually pay for extra liaison with the wider network around a child so if you are going to offer this as a service, you will need to negotiate with the family how you will get paid for this.

3. How can they prepare for meeting a new family?

You should consider who to invite to the the first session and if you will need more time and/or a separate waiting area if you decide to spend time alone with the child and/or their parents. It’s usually a good idea to set some time aside at the end of your session to talk to the child alone to establish a rapport but only if the child or young person feels comfortable with this idea.

You should think about what extra toys or materials you might need to help the child or young person feel comfortable in your therapy room and engage in the session. For younger children, you might consider having toy cars or figures and for older children, you could offer some fidget toys. All children enjoy drawing, and this can help them answer some more challenging questions. In some cases, playing games can also help.

Make a therapeutic contract with each new family that states what they can and can’t expect from you and what they need to do to get the most out of therapy. This can include how and when you will feed back to parents and what days and hours you are available to be contacted. This will avoid any future misunderstandings or misconceptions.

4. How has moving to online work changed your job?

Moving online during the 2020 and 2021 lockdowns impacted the world of CYP therapy tremendously as some cohorts, such as very young children and young people with social phobia found it difficult to engage with online therapy. This led to delays in their treatment until we started offering in person sessions again. Meanwhile, older teenagers who often prefer or at least feel more comfortable with being online were able to engage with online sessions but sometimes had concerns about confidentiality due to being in close proximity to family members in their homes.

5. What is your advice for interacting with schools?

Right away you should try to learn the names of all the important adults in the child’s life at the school. It can be helpful to make contact with their main teacher, SENC0 or counsellor to gain their perspective on the child’s difficulties in that setting.

This can help build an accurate picture of the child’s needs and together you can come up with strategies to support them at school and make their life there easier. Measures that schools can put in place for this purpose include: giving the child “time out cards” to discreetly ask to step out of a lesson; opportunities to spend lessons or break times in a learning support area; reduced timetables; and Emotional Literacy Support sessions where they learn about how to make friends and cope with difficult feelings in small groups.

6. Do you have an example of a tough ethical situation you’ve had to navigate during your work with CYP? How did you deal with it?

When working with children, safeguarding them from harm always comes first, but at times putting this first can jeopardize your professional relationship with them. An example is when a girl I was working with went missing, her parents contacted me to ask if she had said anything during her sessions with me that might help them find her. Although I didn’t have any information about her whereabouts, I did have information that could help them understand better what her frame of mind was during our last session and that could indirectly help them find her. I also felt that she was at significant risk the longer she remained missing.

As such, I decided to break confidentiality in order to help her family find her and bring her to safety. She thankfully understood in this case but since the entire relationship with a client is built on trust in that confidentiality, it’s always a risk to the relationship to have to make the call to break it and can lead to the child feeling betrayed if they don’t understand why.

7. Is there anything in particular therapists should think about when ending a piece of work with a CYP?

I think its always important to work towards leaving CYP with a positive experience of therapy because you want them to feel they can access it again at anytime in the future. You should think about summarizing the work you have done together, including where they were at when the work started versus now, what strategies they have learned and how they have demonstrated their ability to use them. You should also make sure to emphasize the qualities and strengths they have brought to the process that enabled them to achieve their goals.

This will boost their self esteem and help them feel more confident about continuing to manage their difficulties by themselves. Putting this in a therapeutic letter means they can revisit the summary whenever they like. Planning a final review session or writing a final feedback letter to the family is also a good idea.

8. What is the one thing you wish you knew when you were starting out working privately with CYP?

There is sometimes a difference between what parents and children and young people want from therapy and this can cause tension when it is parents that funding their child’s therapy. I wish I had been more aware of this when I started working privately with CYP as I would have started using therapeutic contracts earlier.

If you specialise in working with children and young people and would like to do some private work, please contact Surrey Therapy Practice at enquiries@surreytherapypractice.com