with Alfi e. T is discussion led to sharing ideas and experiences of the creative and playful ways that team members have worked with children, drawing on the work of therapists such as Wilson (1998) and Epston (Freeman et al., 1997). I shared some of my ideas, including the range of visual resources that we have developed in the family therapy team. Many of the children and young people benefi t from visual ways of communicating, both to support their cognitive abilities, such as memory and at ention, and because many children fi nd visual information easier to process. T e resources we use to support communication in families include pictures of a range of emotions, feelings thermometers, social stories and comic strip conversations. I shared a framework for preparing for


family therapy sessions with children and young people with a diagnosis of autism or a learning disability. T is is to gather information before meeting a child and family, or it can be used as a basis for curiosity in sessions and for asking systemic questions. T is includes fi nding out about the child’s ability to understand language and how they communicate, fi nding out about the child’s cognitive strengths and diffi culties, any sensory or physical diffi culties, and how a diagnosis such as autism infl uences the child’s development. It is followed by a question about how this might help with hypothesising about the infl uence of the child’s diagnosis or disability on family relationships, and on their own identity. T en a question asking how this might infl uence communication within the family and within family therapy sessions. With Alfi e, this information gathering


led to fi nding out he could understand one or two spoken words and that he was in the early stages of learning to use symbols to request things he wanted. His autism aff ected him in a signifi cant way: he had particular interests, found structure and predictability important and found it diffi cult to manage change. T is professional “knowledge” helped us develop hypotheses about the infl uences of Alfi e’s diagnosis on him and on family relationships and to generate systemic questions from a position of curiosity. T e next family session was created as a play-based session where the family communicated through doing activities together as well as talking. T is provided


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an opportunity to be curious together about family interactions, to notice what was working well and to think about the challenges that came up. T e following session with the parents provided a chance to refl ect on this further: many of the dilemmas that had brought them to the service came up in the session. We saw Alfi e become distressed when his parents suggested that his younger sister had a turn on a mobile phone: he played briefl y with his family and then moved away to play on his own with a train set. At the end of the session, he found it hard to stop playing and to leave the train set behind. We noticed how diff erent family members supported him at these times and asked questions that ‘thickened’ the descriptions of what was working well and were curious about the meanings that the family were making. We were also curious about how family members supported each other and how they felt at these times.


T e infl uence of the child’s diagnosis on family relationships When Alfi e was referred, the therapists


and assistant psychologist shared their hypotheses that the family didn’t have a shared understanding of how his diagnosis of autism was infl uencing him. T ey had suggested several approaches to communication and supporting Alfi e’s behaviour that are oſt en helpful for children with a diagnosis of autism. T ese included using visual supports, visual timetables, now and next symbols and timers to help Alfi e understand when it is time to move from one activity to another. Denman et al. (2016) found that families waiting for an autism spectrum condition assessment oſt en experience diffi culties explaining, or making sense of, the referred young person’s behaviour; we hypothesised that this continued to be a challenge for Alfi e’s parents. T e family therapy team were also curious about what understanding his parents had of his diffi culties with learning. T ey had said that they thought he would go to university when he leſt school. T ey could also use complex language with Alfi e, which other assessments suggested he would struggle to understand. In response to this, I suggested a


mapping exercise drawing on McKenzie and Dallos’ (2016) “self-autism mapping”. T ey developed this approach for children with autism to communicate about their


own identity and to move away from a totalising and oſt en defi cit-focused identity. For Alfi e’s parents, this provided a visual way of mapping out together their ideas about how autism infl uenced him, but also how being a six-year-old boy infl uenced him along with his stage of development. T e therapists drew intersecting circles that represented the infl uence of autism, his stage of development, and being a six- year-old boy. T e therapists asked about diff erent behavioural and communication episodes and asked his parents to think about how they thought these parts of his identity were infl uencing him at these times. T is included thinking about Alfi e’s diffi culty with fi nishing playing with his iPad, his particular interest in playing with trains, and his distress when he was out with his family in the supermarket. T ey put Post-its on the sheet with their names on and the therapist also shared their ideas in the same way. T is led to a rich discussion about the diff erent ideas and hypotheses that were shared. T is was a way of being curious about these diff erent ideas, and of talking together about professional knowledge alongside the parents’ knowledge. It was also a way of moving levels of context from the level of interaction to one of beliefs and meaning. T is led to conversations about what


a typical six-year-old might do and what was similar or diff erent for Alfi e. T e therapists asked relational questions about what they and what his brother might have done that was similar or diff erent when they were six years old. T e family agreed they would like more information from his school about how he was doing compared to other children the same age in his class. T is enabled the parents to begin to think about how having an intellectual disability was also infl uencing Alfi e along with his diagnosis of autism.


Refl ecting conversations to engage families and children with disabilities We found, when we tried to have


refl ecting conversations, that oſt en the children would become very active and that it then became hard for their parents to listen to the team’s ideas. T e therapist oſt en found the team’s refl ections helpful, but they didn’t seem to be engaging the family. I had read Brown’s (2009) use of refl ecting puppet shows with children and their families. He had successfully used puppet shows with children and


Context 170, August 2020


“Systemic suitcases, storms and smooth sailing”: Some of my experiences of supervising a family therapy team in a CAMHS disability service


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