I was sitting in my tiny office as a young resident at the Child and Adolescent Psychiatric Hospital, Denmark.
I was trying to keep track of what the mother, Sheila, was telling me. At the same time, I was desperately keeping an eye on her six-year-old son, Hans, who was climbing the furniture and getting into everything. The mother was describing the troubles Hans faced at school, the complaints about him from people in their residential complex, the difficulties in raising him, and her fears for his future, which she already imagined being corrupted by crime and drugs.
By now, Hans had emptied the toys onto the floor and flipped the trash can so he could use it as a shed for farm animals and racing cars. He talked constantly about everything and nothing. Despair invaded my brain, telling me that this mother was unfit, and her son was out of control. I tried to respond with empathy and common sense to invitations from Hans to play and, simultaneously, give full attention to his mum.
However, thoughts about the difficulties of my job were interrupted by other thoughts: How awful must it be for the mother and son here in my office? Does the mother expect me to see her and Hans as failures? What might they need most right now? Perhaps their biggest need is for respect and acknowledgement from a health professional like me?
The whole family deserves help together
This experience happened many years ago. It spurred my desire to find ways to become an empathetic doctor offering helpful help. I began a journey that became a never-ending journey to become a narrative family psychiatrist, and it fills me with joy. My practice of narrative family psychiatry progressively evolves from a foundation of science and collaborative values comprising respect, curiosity, trust, and hope.
My overarching principle is this:
When a child is struggling with a psychiatric illness, their family struggles, too. Therefore, the whole family deserves help together.
I do not believe in individual therapy for children. Imagine a child saying, “Hey Mum, I have learned these new things about myself, and I will act differently from now on. Therefore, I expect you to change your behaviour accordingly.” That situation would be impossible for a child. I believe parents are in a better position to change the way family members interact with each other and their problems.
Narrative family therapy forms basis of treatment
I founded a Family Therapy Team in the Child and Adolescent Mental Health Services of the Capital Region in Denmark. Our purpose was to develop a treatment based on narrative family therapy to help families struggling with complex psychiatric problems so severe that regular treatment, both in the hospital and in the community, had been inadequate.
We have these visions:
- Combining narrative therapy and the bio-psycho-social model used in the health care sector to address psychiatric problems.
- Taking a family approach, not an individualistic approach.
- Creating a team culture consistent with narrative ethics.
- Honouring and using the knowledge and wisdom of people who seek help in psychiatry.
When I began training in psychiatry in the 1990s, the stigma and taboos of psychiatry were paramount. There was a lot of secrecy and disrespect for psychiatric patients in society. The way health professionals and society view mental health problems and psychiatric illnesses has a profound effect on how we treat the illnesses and the patients. Not that long ago patients with cancer were met with disrespect and even contempt. That is no longer an issue. I hope the same will happen in psychiatry. Child and adolescent psychiatry is a messy and a wonderfully fascinating endeavour, and meeting families struggling with mental health issues with respect, curiosity, trust and hope is healing.
Family is not the problem but has key to solving the problem
Psychiatric illnesses are communicative and relational in their very nature and so do not only affect the individual person but affect the whole family. This is also true when the parent has a psychiatric illness. But the family is not the problem, the family has the key to solving the problems. The road to recovery from psychiatric illnesses is through family-collaboration based on the ethics of respect, curiosity, trust, and hope.
The basic principles and practices of collaboration involve:
- Meeting the person with the expectation that they are worthy of our deepest respect.
- Sharing the power of decision-making with the family.
- Sharing expert and insider knowledge instead of prescribing it.
We must reduce the stigma of psychiatry and encourage medical services to build teams and organizations with leadership that honours the ethical principles of respect, curiosity, trust, and hope.
I teach trainees in child and adolescent psychiatry. When I began using our guide (also known as a manual) on collaborative family therapy in my teachings, I received positive reviews, but also many complaints and demands. The trainees liked the structure and clear guidelines but wanted more examples on how to do it. They said, “It lacks those stories you tell us. We learn from those stories and carry them with us”. That feedback inspired me to start writing stories, and the idea to write Narrative Psychiatry and Family Collaborations was born.
Narrative Psychiatry and Family Collaborations contains stories about helping families with complex psychiatric problems by seeing and meeting the families and the family members, as the best versions of themselves, before we see and address the diagnoses.
Vision for child and adolescent psychiatry to become family psychiatry
My vision is for child and adolescent psychiatry to become a family psychiatry offering co-created treatments. I want to inspire helpers to become co-travellers with the family on their journey towards a better future and collaborate with, rather than “operate on”, the family.
I use externalizing language in Narrative Psychiatry and Family Collaborations, based on narrative theory and poststructuralism. My hope is for this book to be a living example of the principles put forward. For example, narrative therapists do not write, “I am depressed”, but rather, “I am struggling with depression” or, “I am attacked by anxiety”. When we experience how the language constructs our experiences, taking care and being gentle becomes imperative in using our words. I hope you as a reader will experience that this book is a gentle book.
Narrative Psychiatry and Family Collaborations contains more than my voice. Families with experience with our collaborative work also participate. I sought their opinions in deciding the content and they were invited to read the drafts. The book contains e-mails, descriptions, and comments from family members to validate and enrich the stories.
Weaving of personal and professional values into helpful narratives
I want to inspire professional helpers to become the best version of their professional self. During the writing process I’ve imagined that I am telling stories to my younger colleagues and trainees who work with families struggling with mental health problems. The narrative approach to teaching has inspired me for many years, especially the concept of exemplary tales. I hope my stories can become such tales and be applied in this way.
Chapters in Narrative Psychiatry and Family Collaborations are organised according to ideas, values, and techniques. The initial focus is on family-oriented practices. Then book then weaves through narrative collaborative practices, narrative psychiatric practices, and narrative agency practices. The final chapter is about daring to weave personal and professional values into a patchwork of narratives about who we want to be. When witnessing people as the best possible versions of themselves, we experience the transformations that occur within their lives.
I hope the stories shared in Narrative Psychiatry and Family Collaborations will inspire your professional journey, by inspiring you to remember, tell and re-tell many stories about who you want to be, both as a person and as a professional, and what stories you want to be told about you.
I wish you all the best,