Observing and formulating

During the assessment period, the art therapist seeks to understand what is happening in and around the child.

The therapist's focus is on

• understanding the child’s relationship with their primary caregiver

• getting a clearer picture of the adult, the child and the wider systems around the child

• thinking about what might be helpful including making decisions about the feasibility of dyadic work

Understanding the relationship between the child and the primary caregiver

In terms of understanding the relationship between the child and the primary caregiver, it can be helpful to observe the dynamics and interactions between them in joint sessions. This helps the therapist to understand issues which might not be so apparent during individual sessions with the child.

The therapist pays attention to

• how the children signal their needs and feelings to their carers

• whether or not carers pick up on these signals

• how carers respond to signals

• the emotional availability of carers

• how decisions are made

• patterns of interaction that have developed

Getting a clearer picture of the adult, the child and the wider systems around the child

In terms of getting a clearer picture of the adult, the therapist seeks to understand the extent of their capacity to think about their child and also their own experience of being parented.

In terms of building a picture of the child, the therapist tries to understand the therapeutic needs and the child’s level of understanding including emotional literacy.

With children in care, the therapist may also be thinking about whether the carers are going to be able to maintain the placement and to what extent they are willing or able to put in the work to do so. The therapist will take into account the child’s past history and their current placement, and how the child feels about where they had been placed.

Therapists also think about other significant people involved in or with the family, and how they might play a part in therapeutic work. People from the wider system may be involved in network meetings and review meetings.

Feasibility of dyadic work

In terms of thinking about what might be helpful and whether dyadic work was feasible or not, the therapist thinks about

• the length of the intervention

• the frequency and format of sessions

• the timing of the intervention

• the adult and child’s capacity to make use of the work.

If the adult is unable to think about the child, or openly hostile, then this could lead to dyadic work being ruled out.

If a parent is aggressive or unable to demonstrate emotional warmth to a child then referral to other agencies such as children’s social services should be considered.

After the assessment

It may be useful to formally share any understanding that had been gained with the family. This may involve writing a therapeutic letter to the family outlining thoughts and observations of the family as well as conversations which have taken place during the assessment process.

Related goal

This step is related to achieving the goal assessing what is needed and what is feasible.