Managing difficult conversations
• Offer the family an opportunity to use us to have a different conversation from what they would have at home
• Use power relation to take control
• Sequential, individual, observed conversations

Often in work in mental health services we are engaging with families to support one of their members. In this context the family is not seeking our help as a family. We have found that a number of families we work with are not receptive to being offered family therapy and understand this recommendation as an indication of judgment and blame. We have found that families are more open to the idea of an opportunity to use our professional support to engage in a conversation which is different from the conversation they would have at home, with the possibility that some movement and new ideas might come out of it.

It can be very helpful to use the power relation to take control, such as in a 'lose-lose' argument, or negative conversation. Interviewing each person individually, using the therapeutic strategies for bringing forward resource, with the other listening can often enable movement. If the person in the listening role interrupts, ask them if they can hold their concern and ask what sort of support they need. Write it down, etc, and come back to it. For instance:

"I’d like to stop you here and reflect a bit on the conversation."
"Is there anything new happening in this conversation? Are you learning something?"
"Is this the sort of conversation which happens a lot at home?"
Is it helpful, is it working for you?"
"Would you like to try something different?"
"I would like to try interviewing you one at a time."
"I am not 100% sure how helpful this would be but it would give you an opportunity to have a different sort of conversation."
"I will stop after a bit and I check as to how you are finding it."

When a family is using judgment to undermine their own processes, the agency and decision making processes involved in this can be brought forward, the values and intentions which support it made explicit and the effect of it considered.

"We don’t cope with that very well."
"How did you work that out? Is there a standard of parenting you measure your family against?"
"When you have that sense of “not measuring up” what effect does it have on your parenting?"
"It sounds as if you have put a bit of thought into this, into the sort of parenting you are wanting to be doing. It sounds as if you are describing a range of ideas as to what is important to you in parenting and placing a strong value on doing the very best for your children."

When one family member is talking for another, there can be a risk that that person is missing out on a possibility of engaging more directly in the conversation. If we make this explicit, we can bring forward the intention and consult with them as to how well the strategy is working.

"I notice you are helping Mandy with answering some of the questions. Do you have some concern that the questions may be difficult for her to answer, or perhaps that I need information that is more full than she can give?"
"Should we check with Mandy if her ideas are the same as yours or a bit different?"
"Mandy, do you feel 100% agreement with what your mum is saying or 50%? Would you like your mum to keep helping you like this or should we try something a bit different?"

Sometimes when a child or young person is not talking, we can consult with them as to whether it would be helpful if the supporting family member took up a role of speaking for them.

"I notice it doesn’t seem easy to talk here. Is there anything I can do to make it easier?"
"Would you like your mum to tell some of the story to begin with and we can check it with you as to how much she is getting right from your point of view?"