Answering this question is likely to determine the success or failure ofwhatever intervention you employ. When a parent, teacher, grandparent, or caregiver leads a reluctant kid, by the hand, into our consulting room, sits him or her down, and proceeds to list off all their problems, what do we see as the goal? Is it what the parent wants the child to do or be, or what the child wants? What if the parent says that a child's behavior is causing unacceptable sibling conflict or threatening the parents' marriage, and the child says he or she does not care? What if a child says that, because kids at school are bullying him, he wants to take his father's gun and shoot them all? Do we listen to the express goal of the client or take a morally, socially responsible stance? And how do we match this with our ethical responsibilities? Exploring the child's goal in a specific, solution-focused approach with questions (like, "How would you prefer to be feeling about the other kids?" "What things can you do other than taking a gun to school?" "What do you think you can do to help form better relationships with them?") may differentiate between the actions of the bullying and the perpetrators of those actions, thus highlighting the point that the child's goal is to cope better with the bullying and relate better with his classmates rather than to kill them. This then becomes a workable therapeutic goal, and balances the goal of the child with the well-being of others.
A story that has remained in my mind since schooldays is the tale about little Johnny who was caught kissing a girl in class. His teacher sent him to the principal, who sat behind his big, wooden desk, pulled out a large blackboard ruler, slapped it on the palm of his hand, threateningly, and said, "Listen son. I will teach you to kiss girls in class," to which little Johnny replied, "But, sir, I already know how." Johnny's teacher and principal had a problem with his behavior. Johnny did not.
In the case ofJessica, the six-year-old elective mute I discussed in Chapter 1, several people were involved in her coming to my office, and all wanted the best for her. Her grandmother, who initiated the appointment, wanted to see Jessica talking like other children. Jessica's teacher had the problem that Jessica could not be assessed—as the system specified—and wanted her to meet these requirements. Her mother did not see a problem as Jessica was garrulous at home, and would probably speak at school when she was ready. As for Jessica, it did not bother her apart from being teased by other children.
All this raises the question, "Who is the client?" Is the outcome to help the grandmother feel she has a normal granddaughter, make the teacher's job of assessment easier, accept the mother's position that nothing is wrong, relieve Jessica's discomfort about being teased, or a combination of these outcomes?
Berg and Steiner (2003, p. 14) point out that never in their combined careers (nor I in mine) have they had a child telephone and say, "Doctor, I have a problem. Can I make an appointment to sort it out?" Generally, children are brought to therapy by parents, teachers, caregivers, or custodians like social workers, police officers, or probation officers. Of course, there may be exceptions to this depending on the context in which you are working, the nature of your relationship with your clients, and the way your clients perceive your availability. One of my peer reviewers who works in a school environment said it is not uncommon for her to have students knock on her door and sit down for a chat about something that has been bothering them.
Frequently, however, the child does not know what to expect, may not have been told the purpose of the visit, or may even have been given a fabricated story. Recently a parent requested hypnosis for a child with a behavioral problem. She told the child I was a man who did magic. The son probably expected a birthday party entertainer who could pull rabbits from a hat or make things disappear. With this expectation, it was obvious I was going to be a disappointment to him from the beginning.
To follow up this question ofwho sets the therapeutic outcome, I would recommend the chapter entitled, "Assessing Your Clients, Agreeing on Goals" in Children's Solution Work (Berg & Steiner, 2003, pp. 32—47), as it provides a useful approach to negotiating goals with children and their caregivers. In addition, I have elsewhere (Burns, 2001, pp. 321—237) given a fuller description, and an adult case study, of the Outcome-Oriented Assessment that I have summarized below.
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