No child or young person should receive psychotherapy without their parents or caregivers also receiving support, according to a new book that calls for a “sea change” in youth mental healthcare.

Rather than treating distressed children or those with behavioural challenges as isolated cases, which is still the case in many children’s and young people’s services, the book – by the Cambridge University-based child psychotherapist Alix Hearn – argues that the care system should actively support and help to heal their parents alongside them.

The book calls for children and young people to be thought of as part of an ‘ecological system’, which, it adds, is often overlooked by services that are over-stretched, under-funded and focused on short-term, crisis management. Hearn suggests that improving youth mental health requires a move away from simply seeing the problem as medical, and instead understanding the familial, social and cultural context for their feelings.

The book calls for children and young people to be thought of as part of an ‘ecological system’, which, it adds, is often overlooked by services that are over-stretched, under-funded and focused on short-term, crisis management. Hearn suggests that improving youth mental health requires a move away from simply seeing the problem as medical, and instead understanding the familial, social and cultural context for their feelings.

"Ghostly" attachments

Her case for a family-based, eco-systemic approach draws from attachment theory: the principle that children have an evolutionary need for a secure emotional base, usually provided by parents and carers, from which they can explore the world.

While it is widely accepted that children are more likely to struggle when that support is absent, Hearn points out that adults’ parenting styles are themselves influenced by how they were parented.

As a result, families are partially defined by “ghostly attachments” – learned behaviours that are passed down, often unconsciously, through the generations. Hearn argues that every family carries “unremembered hauntings” that affect behaviours such as how they express, manage or shut down emotions, and that effective therapy should mean working with both parent and child.

Her book, Places of Safety, which will be launched at an event in London this week, also links record levels of youth mental health difficulties to a wider sense that “the world is burning”. Climate change and global instability, she argues, are compromising children’s sense of safety – an anxiety often absorbed from the adults around them.

“At the moment, many services working with children and young people still focus on treating a child as an individual who needs fixing, curing or improving in some way,” Hearn said. “In fact, children are often receptacles for adults’ unprocessed feelings.”

“When a child is referred for therapy, it may be that the parent/carer also needs support . In an ideal world, no child would be seen unless their parent or caregiver was also part of the process.”

Hearn is a teaching associate at Cambridge’s Faculty of Education with 15 years of clinical experience. She argues that youth mental health referrals often involve unmet attachment needs. Children who are withdrawn, aggressive, or at risk of self-harming, for example, may be responding to a lack of emotional support or comfort.

Parents’ capacity to meet those needs, however, is often influenced by their own childhood. Part of the task for child psychotherapists, Hearn argues, is to identify and unpick the ghostly attachments that may lie behind a referral.

Young people’s behaviour may, for instance, be shaped by episodes that they cannot remember from early life, or by the way their parents have processed – or not processed – aspects of their own upbringing. The book highlights cases where responses to mass traumas, such as the Holocaust and other genocides, are often passed down within families.

Hearn said that she was particularly affected by current wars around the world while researching the book’s sections on ghostly attachment and epigenetics – the ways in which genes can be ‘switched on’ or ‘silenced’ by environmental stress.

“The horror of these conflicts is not just about what’s happening now,” she said. “For children who survive, there will be echoes that affect their children and grandchildren. More attention needs to be paid to how we anticipate those intergenerational consequences.”