The benefits of sharing house-tree-fire-water-person drawings with parents when their anxious child is in therapy

Abstract

While the literature is clear that children's mental health resilience can be bolstered by effective parenting, child psychotherapy, and enabling psychologist-parent alliances, it is less clear how psychologists might facilitate all these processes simultaneously. In response, I investigated the benefits of sharing the House-Tree-Fire-Water-Person (HTFWP) drawing with parents when their children, aged 10 to 12, diagnosed with generalized anxiety disorder (GAD), were in sandplay therapy. I drew on the Multisystemic Theory of Resilience that explains resilience as the child's capacity to thrive in the face/aftermath of significant stress as being dependent on resources within themselves and their social and physical ecology. I employed a qualitative approach with an exploratory, instrumental, multiple case study design. My sample consisted of seven purposefully selected cases, involving nine primary (parents) and seven secondary informants (child-clients). I used reflexive thematic analysis (RTA) to identify patterns and themes in the data. The findings of my study demonstrated the benefits for the parent, psychologist and child. The parent(s) acquired heightened insight into their child’s anxiety and felt supported and effective in their caregiving role. The psychologist benefitted from the facilitation of an alliance with the parent and the drawings provided feedback regarding therapy progress. For the child, there was increased potential for therapy gains to be sustained and understanding and connection was fostered. Supporting children’s mental health resilience requires input into multiple systems (the child and their parents). The contribution my study makes helps establish evidence-based practices that not only enhance the parent-psychologist alliance but also optimizes the therapeutic process for children experiencing anxiety. In addition, the findings of my study are distilled into insights for other mental health professionals wanting to use the HTFWP drawing to bolster the resilience of children diagnosed with GAD.