Something is definitely going well in child psychiatry and youth care. “Write that down,” says Carlijn Welten (38). But help for children and adolescents can become much more effective and efficient than “suddenly” by care providers who, as soon as the suffering becomes severe, “immediately hand over a tissue instead of naming pain,” she says.
With her partner Niek Hayen (41), Welten has developed a method that they apply in Het Huis, their healthcare institution on the outskirts of Haarlem. Both are child and adolescent psychiatrists. They do not treat children in psychological distress individually, but involve the entire family: father, mother, brothers and sisters, grandparents. Because much of what the children are going through, they say, is caused by “dysfunctional patterns that are passed down in families.”
Treatment rooms of Het Huis, a mental health institution for children and young people from 7 to 24 years old.
Photos Olivier Middendorp
“Parents pass on their own shit to their children,” says Carlijn Welten (also a former top hockey player). It often does not come out of the blue that young people feel sad or anxious, behave aggressively or develop an eating disorder. It cannot usually be traced back to a congenital defect. Welten, firmly: “An anxious mother raises an anxious child who in turn raises anxious children. A father who has often been hit in the past hits his own child. Many of our ‘housemates’, as we call our clients, actually say with their complaints: ‘listen family, how we have been dealing with each other for generations no longer works for me.'”
And so for six weeks, twice a week, not only children with complaints, but also their family members, come to Haarlem. Welten: “The basis of our treatment consists of three to four generations. We have to understand the family in order to understand the child. So if a child is suffering, for example wants to die, then everyone has to get involved.” She calls this “bizarrely very radical,” because “care for children is usually focused on diagnosing a condition or disorder.” And then “there is no discussion with the family – or usually only about the child.”
ADHD or other disorder
Hayen gives an example. “We recently had a father, mother and daughter. Two years earlier, their son had died of cancer. The girl suffered from depression, self-harm, and concentration problems at school. Then you can put her through the diagnostic mill and diagnose ADHD or another disorder.” But, says Hayen, “if you zoom in, you see that she cannot get around to mourning her brother for fear that her father will collapse and also her mother, who has always remained very far away from emotions. And to understand that mother, you have to know how her family used to mourn. So before that girl even gets around to mourning, you have to relieve her of the worries about her parents.”
Both psychiatrists and ‘system therapists’ believe that there should be more talk about ‘intergenerational trauma’, both in the social debate and within families. They recently launched a national campaign: ‘Don’t pass on your shit’. One of the texts: “We see that children every day […] be treated for complaints that are not just theirs. That has to change.”
In our working method you are not a child who is always gloomy, you are like that because you have to adapt to a system in which you no longer want to participate.
The psychiatrists have seen almost four hundred children and their families since the House was founded. Welten: “The majority wear their parents’ shit. Five or ten minutes after they come in, we say: ‘Your task is completed, we are now going to watch this with the whole family’. They all really like that.”
Hayen: “In our working method you are not a child who is always gloomy, for example, no, you are like that because you have to adapt to a system in which you no longer want to participate, in which everything is hidden away. In this way you show what your family needs to do something with.”
Therapy room in healthcare institution Het Huis in Haarlem.
Photo Olivier Middendorp
Blindfold on
NRC spoke to some ‘housemates’ and their families who have undergone treatment. Their surnames have been omitted for privacy reasons. “My husband and I were looking for help for our nine-year-old daughter,” says Femke (49), also a psychiatrist. “We quickly had explosions in the house, my daughter in particular could suddenly become angry and scream very loudly. We had already registered her with regular care, where the waiting time was more than forty weeks. Moreover, I knew: they would probably give our daughter pills for ADHD. The House was different. For her treatment we not only had to come along ourselves, but also bring our own parents. These were both our fathers.”
Femke says that three hours were immediately set aside for a joint session. “It became visible that these explosions also occurred in ourselves and previous generations. It also became clear how much responsibility my husband and I had within the family as children, partly due to the frequent absence of our fathers, which they also acknowledged.”
During a later session, all family members had to place each other in a room, walk up to walls while blindfolded, and stack their concerns like blocks. According to Femke, this made it clear “that you have been through a lot that quickly triggers you, which your own child feels and also triggers her. In this way, our situation was not so much normalized or diagnosed, but above all recognized. Our daughter now also feels less alone. And we try to deal with each other’s vulnerability and unreasonableness in a loving way. My daughter says ‘would you like to hold me now?’ or “I think you need a hug, mom.”
Tired after hockey
Liselotte (20) had to be operated on for a brain tumor when she was eight. That had “quite serious consequences” for her mental health. Since then she was dependent on medication, exhausted and gained many pounds. “I was a popular girl, but after returning to school I was left out by friends; some parents did not understand that I was too tired to go to a party after a hockey game.”
Liselotte was in therapy for years, but became increasingly depressed. “I was very unhappy with myself. That was not treated.” She started smoking cannabis and self-harm. Six years ago she ended up in a crisis service and was treated for ten weeks. “For my behavior. But not for my real problem: that I didn’t think I was worth anything. Only diagnoses were made and signaling plans were made.”
The House in Haarlem was a turning point for Liselotte. “What I really liked is that they immediately said: ‘holy shit, what the fuck you have experienced everything, it is logical that you feel so terrible.’ And then work on how I can love myself more.”
During treatment I saw my brother cry for the first time, remembering how he had to feel that I was being bullied and belittled
Her parents and two older brothers were also involved in the treatment. “In conversations and through all kinds of exercises it became clear that I was sometimes difficult, but that everyone had a way to deal with it.” Her father wanted to “get a grip” on the situation, tried to spare her mother and would rather not have Liselotte burden her too much. One of her brothers avoided the tension as much as possible. “But during the treatment I saw him cry for the first time, remembering how, at the same primary school as me, he had to see me being bullied and belittled, that I went home crying. I never knew it affected him so much.” The bond with her father has also improved.
Watch a movie
Sometimes Liselotte still has a hard time, but now she has “handles”. “They made it clear to me that I am a top girl who does not have to smoke pot or cut herself to suppress feelings or because I do something wrong, that if I feel bad I can just watch a movie or call my mother or a friend.”
Their approach is scientifically proven, say Welten and Hayen. That is to say: from research that will soon be published in the British Medical Journal for Psychiatry shows “empirical support for a systematic, narrative-based model within child and adolescent psychiatry that goes beyond reductionist, diagnosis-driven care.”
According to both psychiatrists, the long waiting lists can also be reduced by their approach. Welten: “Regular care is not efficient. The treatment often takes a very long time.” Hayen: “Without a family, the dependence on the client and the care provider is very great [zorgproces] is difficult to complete. That’s not that difficult for us, because we have a whole family around us. We often say: ‘We’ll stop doing it, you can do it yourself now’.”
Mental health institution Het Huis.
Photo Olivier Middendorp