Disability Studies Quarterly
Fall 2005, Volume 25, No. 4
<www.dsq-sds.org>
Copyright 2005 by the Society
for Disability Studies


"What seems to be the problem?"
A myriad of terms for mental health and behavioral concerns

Michelle O'Reilly, Ph.D.
Department of Health Sciences
Clinical Division of Psychiatry
The Greenwood Institute
Leicester University
Westcotes Drive
Leicester LE3 0QU UK
Email: mjo14@le.ac.uk

Abstract

The fundamental philosophy of family therapy is to "treat" the family as a unit. It sets out to provide assistance to families with troubles in a way to make them work together in a more functional way. Parents of children with difficulties however, do not necessarily consider the underlying principles of the discipline and seem less concerned with institutional practices. It is salient in family therapy for parents (of disabled children) to locate their child(ren) as the central problem and as the reason for their acquisition of therapy. Using family therapy data, I demonstrate how they construct their "problem child" in interrelated ways, in a way that deviates accountability from them as parents but more importantly works as a display of misunderstandings of mental health issues and concepts. This has wider implications for therapeutic practice and agency responsibility, and further implications for a need for consistent terminology and education for parents.

Keywords: family therapy, disabled children, parents of children with disabilities, mental health issues and children

Introduction

There is now a wide literature on talk in institutional settings (e.g. Drew and Heritage, 1992; McHoul and Rapley, 2001), examining issues such as asymmetrical relationships (those with a presumed power imbalance). I make empirically grounded observations of a systemic family therapy setting and therefore some attention to this framework is needed.

The discursive approach (a language-based discourse analytic approach) has led to new ideas in the context of therapy (see Silverman, 1997, 2001a) and of accountability (see Buttny, 1993; Edwards and Potter, 1992). Furthermore, there is a slight shift towards examining disability more critically (see Finlan, 1994; Oliver, 1990, 1992; Soder, 1989) and some are examining it more discursively (see Mehan, Hertwick and Meihls, 1986; Rapley, Kiernan and Antaki, 1998).

Despite this recent critical turn, there is still relatively little research that adequately addresses the families who experience disability and their interactions within the institutions that they face day-to-day. In my research I move to show the issues that are raised by families in a therapeutic setting and give them a voice in academic literature.

Family therapy

The family therapy movement grew out of psychiatry in response to the growing rates of juvenile delinquency and divorce; in a bid to pay particular attention to the family, it was a consequence of increasing social needs (Broderick and Schrader, 1981). It is argued that the aim of family therapy is not and should not be to develop the "normal" family, as the concept of normality is too complex, instead it aims to make a family functional (Jackson, 1967). This view over time has become widely accepted and it is usual to split families into classifications of functional and dysfunctional (Bodin, 1981), although these distinctions are being broken down, too.

Family therapy has a range of differing opinions and ideas: "The family therapy field is characterized by a plethora of theories about the nature and relative effectiveness of different techniques and by a dearth of research testing these clinical theories" (Pinsof, 1981: 699). I appreciate that there is a diversity of opinion in the field of family therapy, but it is not my concern to consider the effectiveness of therapy or the importance of different therapeutic approaches. Like Labov and Fanshel (1977), I have no issue with the theoretical frameworks used by therapists/practitioners. I focus on the actual therapeutic conversations that take place in order to see what actually is said in this context. I examine systemic family therapy, as this is the type of therapy this group of therapists practice. I do not favor any particular approach. I am also not seeking to lay blame with the parents or any other group. I focus on how they manage their accountability without trying to make claims to any higher reality.

Systemic approaches

The "systems" perspective views family problems as problems of interaction (Masson and O'Byrne, 1984). This approach to therapy is language-based and client-directed concentrating on a relational process rather than step-by-step operations (Larner, 2004). The aim of systemic family therapy therefore is to modify the aspects of the family system that are agreed to require change (Masson and O'Byrne, 1984). In other words the aim of systemic family therapy is to change the way that the family operates as a system. Systemic family therapists look at the family as a whole unit. Carr, (2000) argues that systemic family therapy views the young person at the center of the family system, which is extended to the social system. Interventions for the child involve the whole family.

Disability

Disability is not ignored in the literature, but this generally focuses on aetiology and medical explanations (Caplan and Hall-McCorquodale, 1985; Comer, 1992; Herbert, 1991). There is considerable controversy about the effects and consequences of categorization, and this generates wide criticism from a variety of methodological and epistemological positions, leading to the claim that the population of children who have disabilities cannot be considered a homogenous group (Detheridge, 2000).

Alternative approaches claim that disability is socially constructed, created by the discourses of difference (see Fulcher, 1989; Mehan, et al, 1986; Soder, 1989). This argument emerges primarily from a critique of traditional "essentialist" concepts of disability as being fixed within the labelled individual.

Despite the lay ideas and professional debates as to what the terminology "disability" is by definition, I do not accept that there is a simplistic definition for the phenomenon. It is not my intention to reify the concept by employing data with preconceived ideas about the nature of disability or how to manage these issues. Instead, I accept that people in practice construct their ideas about disabilities. In institutional practice the concept is used broadly to capture a wide range of "problem" children and it is not uncommon for parents to construct their child as the central problem (White and Epston, 1990). Family therapy provides a broad forum for examining how these ideas become reified and constructed by the people who experience it on a day-to-day basis, either institutionally or in the home. There are limited studies employing conversation analytic and discursive approaches to disability and this paper aims to add to a growing body of critical literature by examining the issues raised by parents in the therapy setting. I consider the definitions provided by parents. Service users' opinions are important, and can inform the academic community of the relevant and varying issues surrounding terminology.

Aims and objectives of the paper

In this paper I investigate the ways in which parents and their children interact in a therapeutic setting. I examine how parents talk about their children and the ways in which problems are constructed. I examine the "real" talk of "real" people (from a natural setting) in terms of family interactions in order to give insight into the problems families experience when taking care of a child with a developmental disability.

Malek (2004) demonstrates that mental health is often confused with mental illness despite them referring to different states and it is evident in my data that this confusion runs deeper than these broad concepts. Dogra, Vostanis, Jewson and Abuateya (2005) in their study of Gujarati young people found a confusion of concepts and many confused mental health and learning disabilities, and they displayed varied ideas about the causes of mental health problems. Lauber, Nordt, Falcato and Rossler (2003) show that the general public actually have little knowledge of mental disorders and those beliefs of the general public differ greatly from those practicing in health fields (Jorm et al 1997).

Edwards (2001) shows that people orient to having a therapy related reason to be in therapy. With reference to couples' therapy, he demonstrates that when entering into a therapeutic relationship, clients set out their reasons for needing therapeutic assistance. The parents in my family therapy data, despite the institutional preference for "whole family" work, insist on locating the problem in the child(ren). I focus in this paper on the myriad of concepts parents employ to describe their children in a way that orients to a confusion of mental health concepts. Buttny (1996) demonstrates that clients are not passive recipients of therapy, but active in the process. I show in this paper how they are active in constructing their problems and their children, and how they manage their accountability within this framework.

Methodology

In this paper I take a qualitative approach to investigating family therapy and disability and analyze the data in accordance using the discursive approach.

Data and setting

When taking a discursive approach, there is a preference to use natural data to investigate human interaction. Discourse is a social practice and should be studied as a real world phenomenon and not a theoretical/abstract one (Edwards and Potter, 1992). Natural data is seen as providing a forum for seeing how people construct their social world together (Silverman, 2001b). I have an arena in which natural interactions between children and their parents and a professional body produce interesting, rich, and complex analysis.

I draw on family therapy from a systemic perspective. Data is videotaped (a routine part of the therapy) and transcribed in accordance with Jefferson guidelines, a set of guidelines developed specifically for those who use conversation analysis in some form. See Table 1 for Jefferson symbols (Atkinson and Heritage, 1999).

Participants

The participants in the data corpus (pseudonyms are provided here) are two therapists, Joe Turner and Kim Jones. There are four families who consented to provide data for research purposes. These families have the pseudonyms of: the Clamp family, the Bremner family, the Niles family and the Webber family. The Clamp family consists of the Natural mother and father, the uncle and three children, all boys. The Bremner family consists of the natural mother and her mother (the grandmother of the children) and two boys. The Niles family consist of the natural mother, the step father and four children, three boys and a girl. The Webber family consist of the natural mother, the step father and four children, all boys.

My data totals approximately 20 hours of therapy. An important point to note is that this team of family therapists specialize in families who have one or more disabled children whom present challenging, or inappropriate behavior. Disabled children have contact with many professionals. In this context therapy is usually recommended by the community nurse and then the family are referred to the general practitioner (GP). The GP then refers the family to the team. Therapy is voluntary (although strongly recommended) on the parents' part, (the children are guided by the parents and have little or no say in their attendance). The parents can choose to ignore the advice and refuse therapy. Some of those children enter therapy with a professional diagnosis, whereas other children have their diagnosis pending.

The discursive approach

In this study I employ a discursive approach as typified in the work of Edwards, (1997) and Potter (1996), drawing on conversation analytic techniques as pioneered in the work of Sacks (1984), looking at how versions of the world are produced through discourse.

The focus for discursive psychology (DP) is to understand how discourse accomplishes and is part of social practice, not to uncover the linguistic structure of talk and text (Edwards and Potter, 1992). People using this perspective take discourse to be all forms of spoken interaction and written texts (Potter and Wetherell, 1987). The emphasis is on talk as performance, that interaction is a social accomplishment (Potter and Wetherell, 1995). There are also claims that rhetoric should be seen as a pervasive feature of the way people interact and arrive at understanding (Billig, 1987). In this paper I examine how the clients of therapy accomplish the social action of producing the child as problematic in their talk.

Ethical considerations

Qualitative research is rich and powerful in the social sciences, and therefore, practitioners work through the complications of fieldwork to find less harmful ways of making sense of people's lives (Delaine, 2000). A problem for social researchers however is that ethical considerations are not definitive descriptors of what to do (Berg, 1993). I stringently follow the ethical guidelines set out by the BPS (British Psychological Society). It is important to remember that while the therapist may be the professional and have insight into the BPS guidelines on ethics, the therapist is also a participant in the research and must be treated with the same respect and consideration as the others. All participants were assured confidentiality, anonymity, and respect of sensitive data. Consent was obtained from all adult parties involved.

Analysis

Therapy is a social practice between the client and therapist (Leahy, 2004) and in the analysis I show how this social practice is worked through with multiple members. It is important to consider how the parents manage their descriptions in a way that positions the child(ren) as their reason for needing therapy in a way that suggests that they do not fully understand the range of concepts available. The parents construct their child as a problem in three related ways:

  1. They draw on potential or existing diagnostic labels and present this as the reason for the problematic behavior the child is presenting.
  2. They draw on broad therapeutic and available concepts to describe the child, broad categories such as disabled and handicapped when no diagnosis is available.
  3. They provide lay descriptions and analogies to construct the child such as Schizo and the Incredible Hulk.

Dogra et al (2005) found that the Gujarati community held different views of mental health and mental illness and these views influenced on ideas about services. There is no reason therefore to assume that white families understand the concepts any more fully and my analysis demonstrates that white British families display a level of confusion about diagnosis and childhood disorders.

1/ Potential or existing diagnostic labels

A salient issue for the parents in this therapeutic setting is providing descriptions of the child as the problem in a variety of ways. The parents work together to construct their child(ren) as the reason for their presence in the therapy and orient to the child(ren)'s difficulty as the therapeutic reason and as accountability for the child(ren)'s behaviors. In their constructions they employ a range of available terms relating to behavior and disability. One way in which this is achieved is to orient to diagnostic terms.

Potential labels

In Extract 1 Mr. Niles refers to the media as a source of knowledge and information, orienting to the notion that the explanation to his son, Steve's behavior could be in a disorder.

Extract 1


1. Dad: ↑But I read in an article >in the paper like< 
2.      (.) in this magazine (.) ↑two of the:se things 
3.      about this (.) ↑Autism and this *A D H D and <two 
4.      of the things that it says in there> are just 
5. FT:  Yeah 
6. Dad: <things that he does> (.)

In this Extract Mr. Niles matches up behavior reported through the media with the behavior presented by Steve in a way that presents the television as a source of knowledge for appreciating the way Steve behaves. He uses the terms "ADHD" (line 3) and "↑Autism" (line 2) to reify Steve's behavior. Mr. Niles works up the medical explanations of Steve's behavior through actual psychological terms which he shows are not his own terms. He cites his understanding as being sourced from the media in a way that seeks justification for the aggressive and inappropriate actions Steve is reported to present. This orients to the professional and psychological environment in which the family are present and moves the focus away from their parenting ability and onto a label.

In Extract 2 Mrs. Niles continues the search for a medical term to explain Steve's behavior by providing a direct question to the therapist. This, in turn, continues the construction of Steve as the problem and uses an alternate source of psychological expertise in the therapist.

Extract 2


1. Mum: ↑How do they find out things like that (.) >you 
2.      know< (.)when you've got schizophrenic and ↓that?
3. FT:  We::ll my guess is that (.) er::m 
4.      (1.2)

The inference in Mrs. Niles's question "How do they find out things like that (.) >you know< (.) when you've got schizophrenic and ↓that?" (lines 1-2) is that schizophrenia is one of the potential explanations for Steve's problem behavior. This is another alternate diagnostic and available label for Steve's behavior. This question orients to the potential need for tests to be carried out on Steve as a method for discovering the reasons for his behavior. This again positions Steve as the problem and orients to the need to help him and further displays that Mr. and Mrs. Niles are drawing on available terms in a way that seeks to explain Steve's behavior without a full appreciation of the differences between disorders. Furthermore by showing a range of available labels Mr. and Mrs. Niles suggest a need for a label by working up the importance of one for their son Steve. They demonstrate that they want to acquire the means to see if Steve is "schizophrenic" (Extract 2) or "ADHD" or "Autistic" (Extract 1) orienting to a belief that there is something medically wrong with Steve but failing to fully appreciate the range of medically available labels.

Existing labels

For some of the families who enter into family therapy, there is no need to seek diagnoses as they can on occasion enter into therapy with a diagnosis for their child. In these instances the parents use those labels as a way of accounting for the behavior of the child and as a display of confusion of psychological jargon.

In Extract 3, Mr. and Mrs. Webber contrast two of their sons, Patrick and Daniel to work up the differences between them, despite having the same diagnostic label. This is done in a way as to position Daniel as the problem but also demonstrates some levels of confusion as to why the two boys behave differently with the same disorder.

Extract 3


1.Dad: But there's no sign of it in Patrick (.) >you  
2.     know< (.)>you know< although Patrick's A D H D H D 
3.     like Daniel .hhh but his (.) is the illness scale 
4.     (.) he's down the other end like where .hh nothing 
5.     ple:ases [him and you know (.) = 
5.Mum:          [We've got to see ↑Doctor Peters about 
6.     Patrick 
7.Dad: = >he['s a slob< 
8.Mum:         [He's a slob (.) he's a com↑plete slob >and 
9.     he's a kleptomaniac< 
10.FT: Hu::m

In this Extract Mr. Webber moves to describe Patrick's "ADHDHD" (line 2) in a way that works up the severity of Daniel's and outline the differences between the two boys. The "it" (line 1) being referred to is inappropriate sexual behavior. The confusion of the parents is demonstrated in the contrast between Patrick and Daniel. They construct both children as having ADHD but displaying different sets of problems. Mr. and Mrs. Webber remove responsibility from the family therapist for Patrick's behavior by informing him that they are taking him to "↑Doctor Peters" (line 5) and therefore position Daniel as the problem for this therapeutic setting. They orient to Daniel's ADHD as being the reason for his behavior but demonstrate skepticism in the contrast. Through this they orient to the need for explanations from the therapist here in a way that suggests they do not fully appreciate the nature of the disorder.

In Extract 4 Mrs. Bremner (the grandmother) provides explanations of Bob's behavior through diagnostic labelling. This also works to position Bob as the problem and works to acknowledge the formal psychological setting.

Extract 4


1. FT:  So if <mummy shouted> at ↓you= what would you 
2.      fe:el like? 
2. Bob: Nothin' 
3. Gran:'Well that's true' (.) 'cause he's got Aspergers 

In this discussion Mrs. Bremner (the mother) reports one of the problem behaviors as being Bob's shouting at her. In response to this information the therapist moves to engage the child in the therapy by asking him "if <mummy shouted at you= what would you fe:el like?" (lines 1-2). This works to construct feelings as important and works to make the child an important member of the therapy. Furthermore, it also accepts the mother's report and orients to Bob being the problem. Bob, however, denies feelings and Mrs. Bremner (the grandmother) provides an account for the dispreferred response (Pomerantz, 1984) "cause he's got Aspergers" (line 3). The Aspergers label provides reasons for Bob's behavior and feelings and works to provide a medical construct for Bob as the problem child.

2/ Broad therapeutic and available concepts

The second way in which parents describe their child(ren) as the problem is to use broad descriptive terms that orient to therapeutic concepts and professional jargon. This tends to be used by parents to describe their child(ren) when they report failure as yet to achieve a diagnostic label. This still positions the child within the therapeutic framework and medicalizes the problems in a non-specific way.

Problems and difficulties

A salient way that parents construct their child(ren) is to describe them as having problems or difficulties. This vague construction orients to potential medical diagnostic labels without explicitly stating which disorder it is that is causing the child to behave in the ways reported in a way that demonstrates that they do not really know. This still manages the child(ren) as the reason for being in therapy but does so more vaguely, with less potential for being corrected. When using potential diagnoses they run the risk of being corrected by the therapist. By using broader more vague terms serves the function of blaming the child for the acquisition of therapy without the specific concepts.

In Extract 5 Mrs. Bremner (the mother) contrasts her two children broadly in a way that constructs Bob as the fundamental reason for their need for therapy, but manages the issue of Jeff's "problems".

Extract 5


1. Mum: I'm I'm planning to sort of 'elp ↑Jeff because 
2.      ;he's so handicapped 
3. FT: ↑Yeah 
4. Mum: Although he's sittin' there as [good as gold =
5. Bob:                                       [How 
6. Mum: = today (0.2) but er::m (0.4) you c↓an't you 
7. →   can't help Jeff's problems because ↑Bob overtakes 
8.      everything (.)everything's [dominated. By ↑Bob 
9. Bob:                            [Hey 

In this Extract Mrs. Bremner constructs Jeff as having "problems" (line 7) in a way that is vague and non-descript. She fails to explicate further on what is meant by the concept of "problems" as it is used to contrast with Bob's behavior. She works up Bob as being the reason for the required therapy by demonstrating that Bob is hindering the "help" process for Jeff as Bob's behavior is "dominating" (line 8). It is clear in her talk that she is positioning her children as in need of professional assistance as a way of managing her own presence in the therapy but she only uses general terms. These ideas of "problems" function in a way as to demonstrate to the therapist that she is not an expert in such matters. This is a theme continued in Extract 6.

Extract 6


1. Dad:  Yes you did because you [shut the bedroom door =
2. Mum:                          [Er::m 
3. Dad:   = (.) and then I tur[ned the telly off 
4. Mum:                       [He's got behavioural 
5.       problems

In Extract 6 Mr. and Mrs. Niles work up the problematic nature of Steve's behavior by citing one (of many) examples of Steve's "bad" behavior. Mr. Niles makes reference to an incident involving the television where Steve is reported as being particularly disobedient (and later aggressive). Mrs. Niles moves here to cite an account for the examples of Steve's behavior by blaming it on something therapeutically grounded "he's got behavioral problems" (line 4). As Steve has yet to be diagnosed with some specific disorder this broad available concept works to construct the aggressive and disorderly component of Steve's character in a way that removes responsibility away from the parents. While this broad concept provides an understandable explanation of behavior for the therapist, it is another term applied to Steve's behavior, grounded in medicine, which the parents offer no full understanding of. In Extract 7 Mr. Clamp also provides a vague overview of Jordan's problems in a way that orients to their lack of knowledge about Jordan's condition.

Extract 7


1. Dad: It's a medical problem in't it (.) >you know< 
2.      it's a medical 
3. FT:  So is it something to do <wi::th er::m> (0.8) 
4.      'cause Jordan goes to a special school 
5. Dad: Yeah it is yeah

In Extract 7 Mr. Clamp orients to the medical nature of behavior more directly. He still however maintains the generic vagueness of the concept (Potter and Edwards, 1992). Mr. Clamp here manages his understanding of Jordan's behavior through a broad and vague therapeutically relevant concept "It's a medical problem in't it" (line 1). This serves as a way of displaying to the therapist that the problem is medically grounded and therefore a diagnosis is potentially forthcoming but also shows that he is lacking in knowledge about what the specifics of the medical problem are. This provides Mr. Clamp with accountability for Jordan's presence in the special school but also provides accountability for the range of behaviors Jordan is reported to display.

Disabilities and handicaps

In therapy related jargon, and over into lay understanding, there are broad concepts available to describe groups of children whom have disorders of some kind. They are grouped together under terms like "disability" and "handicap" with potential orientations to political correctness. These concepts work to treat the children as a homogenous group and describe them on the whole rather than provide specific details about individual cases. These terms can be used to describe children whom have received official diagnoses or those awaiting the process. In my data though there is a tendency to only use these broad categories to describe the children without an official disorder.

From Extract 5


1. Mum: I'm I'm planning to sort of 'elp ↑Jeff because 
2.      he's so handicapped 
3. FT: ↑Yeah 

In this Extract Mrs. Bremner (the mother) conceptualizes her plans for her younger son Jeff. She expresses the need for help for Jeff "because he's so handicapped" (lines 1-2). She works up the severity of the need for help by saying "so handicapped" in a way that points to the need to "elp Jeff" (line 1). The concept of "handicapped," functions to provide a broad idea of why Jeff should require professional assistance but provides no related material as to what Mrs. Bremner understands of the term. Sacks (1992) in his work on Membership categorization devices, shows how a category can encompass a wealth of unsaid information. Here Mrs. Bremner points to the need to "'elp Jeff" through the use of a large culturally understood category without the need to explicate further.

Extract 8


1. FT:  So you don't know (.) you kind [of know the word 
2. Dad:                                [Yeah] 
3.      disability 
4. Mum: ↓Yeah 
5. FT:  That Jordan <has a disability> 
6. Dad: We've never ever be:en (.) diag- we've never 
7.      be::en di↑agnosed with it (.) we just >know he's< 
8.      handicapped <and that's a:ll>

In this Extract, it is the family therapist who uses the concept of "disability" (line 3) as a way of summarizing Mr. and Mrs. Clamp's reported understanding of Jordan's problems. Mr. Clamp shows in his narrative that as yet they still haven't received a diagnosis for Jordan and due to this have to use a broader category to appreciate Jordan's behavior. Notably Mr. Clamp changes the concept of Disability to "handicapped" (line 7), a more old-fashioned term. This has implications for political correctness of parents and the difficulties posed by an ever-changing linguistic system in the medical field.

Extract 9


1. Dad: and (0.4) >I said we need one< (.) >and he said< 
2.      (.) "we:ll" (.) >Thomas turned round and said to 
3.      me< (.)we're gonna get you a special one because 
4.      with Jor↓dan being disabled 
5. FT:  Right 
6. Dad: e:r (0.2) you need to 'ave a dis- er (.) bility 
7.      one 

Mr. Clamp here continues with the theme of disability in relation to Jordan's needs. In this discussion about the "need" (line 1) for a social worker, Mr. Clamp works up the distinction Jordan creates by orienting to the claim that they would require a social worker with specialised skills "we're gonna get you a special one because with Jor↓dan being disabled" (lines 3-4). This works to position Jordan as requiring further help and maintains him as the family's problem. The concept of "disability" is voiced in this Extract not as Mr. Clamp's formulation but that of social services. This suggests that the services and agencies involved in families' lives can be a source of information and can provide available terms for use but does not mean that those families appreciate or understand the meanings behind those terms. It also supports the view that the child does have a "disability" in that specialist workers are only assigned to children with particular problems.

3 / Lay descriptions and analogies

Regardless of whether there is an available label to draw on or not, it is prevalent for parents in their descriptions of their children to be more derogatory in their constructions. On many occasions throughout the therapy, parents will draw on lay terms and analogies to convey to the therapist the extent of the inappropriate behavior. They do this in a way that orients to the strong need for help, the out-of-control behavior of the children and their understanding of it. This works as a way of making extreme the day-to-day behavior they are required to deal with and point to the need for the therapist to help the child.

Extract 10


1. Dad: But it (.) >I mean< we've got to sort (.) or get 
2.      him some medication or somet to [calm his temper 
3.      down 'cause he;s schizo 
4. Mum:                                 ['Cause he's not 
5.      sleeping at night-time

In this Extract Mr. Niles orients to Steve's problems as being medically related, seeking resolution in medication "get him some medication" (lines1-2). Mr. and Mrs. Niles seek together to explain the inappropriate behavior displayed by their son. They orient to his aggressive outburst "to calm his temper down" (line 2) and describe him in lay terms as "schizo" (line 3). Schizo is a common lay term culturally understood to relate to someone with mental problems, in a non-specific and vague but often derogatory way. By employing this term, it orients to the lacking diagnostic label and to Steve as being the fundamental problem. It also points to his out-of-control behavior and seeks to remove parental responsibility by showing that medication may facilitate the behavior as opposed to parental discipline. It transcends Steve from just a naughty child, and blames a mental condition for his actions. Notably Mr. and Mrs. Niles provide no further information of what it means to be "schizo" and the therapist proffers no insight or additional clarification.

In Extract 11 Mrs. Webber moves to construct Daniel in a similar way. She moves to demonstrate his unacceptable behavior by showing him in a negative way.

Extract 11


1. Mum: you know (.) so we've got (0.2) small kids either 
2.      side of us now haven't we? (.) and they're in the 
3.      garden it's (0.4) it's like the school said he's 
4.      like a predator

This Extract further demonstrates how lay terms are used to describe children in a way that positions them as problematic and in a negative light. The analogous term of "predator" (line 3) likens Daniel to a wild animal in a metaphorical sense. This works in a way that orients to his predatory nature, seeking out potential others on which to inflict his inappropriate sexual behavior. This negative implication is softened however by Mrs. Webber as she reports the analogy not to be her own but one provided by the school "it's like the school said" (line 4). This functions to deflect any negative judgements of the analogy from the therapist away from her and onto an outside agency, while maintaining the strong image of Daniel. This demonstrates that Mrs. Webber is able to describe the behavior of her son in an understandable way but potentially doesn't appreciate what it means in relation to the disorder of the child.

Extract 12


1. Dad: It's not I mean (.) >to be honest< (.) >I mean< 
2.      (1.2) he can be good he can be bad (.) it's just 
3.      the fact that (.)we've got to get to the bot↓tom 
4.      of why he's like the Incredible Hulk because he 
5.      changes like the weather 
6. FT:  Right 
7. Dad: and if we don't get him sorted. before he's much 
8.      older he's gonna end up doin' some serious damage 
9.      hhh

Mr. Niles here uses more ordinary language to describe his son's behavior in this Extract. He uses analogies in ways that point to the aggressive and unpredictable nature of Steve. Mr. Niles describes Steve as "like the Incredible Hulk because he changes like the weather" (lines 4-5). The culturally understood analogy of the Incredible Hulk relates to the character's rage and shift of personality to one of an aggressive nature. It points to Steve's behavior as unpredictable and this is reinforced by the weather analogy. This narrative displays that Steve's unpredictable and his behavior difficult to understand. There is an orientation to the therapist to help change this unpredictable pattern of behavior through the process of therapy, positioning the therapist as the expert.

Discussion and conclusions

In this paper I have examined the ways that parents construct their children as the problem in their family through a multitude of terms in a way that displays a lack of understanding about mental health issues and behavioral problems. I have investigated the concepts they apply when providing their descriptions and have considered how this orients to their own accountability. This particular piece of research adds to the growing discursive literature on children and disability as well as contributing to discussions of family therapy.

I have looked at how the boundaries of therapy are oriented to by the members of the interaction. Buttny (1996) shows that when interacting within a therapeutic framework, the clients and the therapist will orient to the boundaries of that framework. I show in this paper that the parents orient to the therapeutic framework by providing a therapy related reason for being present: the problem child. But in their descriptions relate to a number of sources for knowledge and suggest a need to know more about their child's difficulties.

The value of analyzing therapy in a discursive way is that it offers an understanding of the therapeutic process based on language rather than interpreting what is hidden in the clients' heads (Madill and Barkham, 1997). It has been suggested that a focus on therapeutic conversation is easily tempted into treating the respondents' speech as a reflection of a pre-existing social or psychological world. To do this in research on therapy/counselling, however, would deny the recognition that talk itself is an activity (Silverman, 1997). Those who practice CA do not operate from this philosophy; they do not assume, as a source for analysis a particular pre-existing reality in people's lives or minds.

This research has important implications for both theory and practice. It is not uncommon for families of children with difficulties to begin to have professional input into their lives. Many face the issues of badly behaved children and the questioning of their parenting ability. A child with behavioral problems can be particularly disruptive in a family and the parents often seek assistance for it. One of the things that family therapy can help parents with, is coping strategies and parenting techniques, but what seems to be prevalent is the parents blaming of the child and a mismatch of understanding the basic concepts and issues. One of the implications for family therapy, therefore, is to facilitate the parents' knowledge and information about their child and the issues that child is facing.

There is a need to appreciate how the parents view their children and to acknowledge the feelings they experience regarding their "problem child." The variety of descriptions parents apply to their children indicates the varied levels of understanding and the need to appreciate what it is that their children are experiencing. The need to educate parents on issues of child mental health and disability are overt in this data. Dogra et al (2005) show that before patients and communities can be involved in service development work needs to be done to establish a shared understanding of key terms between the public and the professionals. While various labels are banded about in the media (see Anderson, 2003, for examples) there appears to be a need for some simple explanations of the medical terms. It is questionable though as to whose responsibility it is to provide such education. There seems to be a clear orientation to the family therapist to provide some level of diagnosis despite this not being within his/her remit, and therefore, there are implications as to how much practical assistance could be provided by the service?

There are also wider implications for labelling children, both theoretically and practically and there is something to be said for parents seeking labels and who is able to provide the service. It points to parental confusion over which service can help with which problem. Maybe there is a need for a particular service to assist with the paperwork and give relevant advice; this is clearly not the job of the family therapist. On a theoretical level, there are many critical debates about giving children labels, but it appears that on a practical level, parents seek them out by way of accounting for their children's behavior and in a way that then seeks to acquire assistance to rectify that behavior. It therefore begs the question of whether we can separate theory from practice and what impact one has on the other?

Because of the weaknesses and limitations of much of the existing literature on disability and related issues that seeks to reify labels and problematize the children it becomes obvious that a wider literature and research is needed.

The turn to language-based approaches to investigate therapeutic talk is only in its infancy and it is clear that much more work is required for us to understand the process of therapy. Family therapy is a broad discipline and we need to understand how it works.

Table 1. Jefferson symbols

Transcription notations:

(.) A period inside parentheses denotes a micro pause, a notable pause but of no significant length.

(0.2) A number inside parentheses denotes a timed pause. This is a pause long enough to time and subsequently show in transcription.

[    Square brackets denote a point where overlapping speech occurs.

> < Arrows surrounding talk like these show that the pace of the speech has quickened.

< > Arrows in this direction show that the pace of the speech has slowed down.

( ) Where there is space between parentheses denotes that the words spoken here were too unclear to transcribe.

(( )) Where double parentheses appear with a description inserted denotes some contextual information where no symbol of representation was available.

Under When a word or part of a word is underlines it denotes a raise in volume or emphasis.

↑ When an upward arrow appears it means there is a rise in intonation.

↓ When a downward arrow appears it means there is a drop in intonation.

→ An arrow like this denotes a particular sentence of interest to the analyst.

CAPITALS where capital letters appear it denotes that something was said loudly or even shouted.

Hum(h)our When a "h" appears in parentheses, it means that there was laughter within the talk.

= The equal sign represents latched speech, a continuation of talk.

:: Colons appear to represent elongated speech, a stretched sound

Acknowledgements

With thanks to Charles Antaki of Loughborough University and Panos Vostanis of Leicester University for reading earlier drafts of this article. Many thanks to Nisha Dogra of Leicester University for her clinical input and advice and thanks to Derek Edwards of Loughborough University for his assistance during the project. Many thanks to the ESRC for their valuable funding.

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Endnotes

1In this family there are two members named Mrs. Bremner, the mother and the grandmother. This will be differentiated by role in this family for these purposes. I am not trying to make any analytical claims about role here in this paper and the differentiation of role will not be referred to in the other families.






Copyright (c) 2005 Michelle O'Reilly



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