This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.

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This article outlines our clinical development as therapists working with mothers and daughters showing a high level of psychological distress and searching for a way to remain connected. We explore the contemporary discourses of mothering and mother blame to enrich our practice and enable women to acknowledge responsibility constructively and move from the paralysis of blame, shame and guilt. Within the context of these restraints we elaborate our model of working which aims to establish a therapeutic alliance with both mother and daughter and enables exploration of the complex levels of contextual and emotional meaning which underpin their relationship. We aim to develop mutual empathy without sacrificing appropriate responsibility. We believe that systemic practice has inadequately addressed these issues in clinical practice. We encourage greater transparency and self-reflexivity in our encounters.

The BIOMED international outcome study on childhood depression offered a unique opportunity for the systematic treatment of children and families with major depression using systemic psychotherapy. This paper describes the experiences of clinicians working with the families referred and the theoretical and clinical models that evolved during the treatment process. The concept of 'keeping company with hope and despair' emerged as an overarching framework for thinking about the quality of the therapeutic relationship in this developing area of clinical practice. We illustrate our systemically informed interventions with case examples and discuss the role played by therapists' 'use of self ' in engaging and fostering change in families gripped by depression. IntroductionOur recent contribution to the development of research and clinical practice in the area of childhood depression (Campbell et al., 2005) led to conversations between us about the importance of a therapist's experience when working in this clinical area. This article is about what is demanded of systemic psychotherapists embarking on family work where a child has been diagnosed with depression. It speaks to the emotions we experienced both during and after family sessions and what sense we have made of these in order to work effectively. A systematic approach to clinical discussion among clinicians proved to be the key to theory building and the interventions described. This paper demonstrates what happens when clinicians talk and think together about what they do. Its conclusions about working with childhood depression have emerged from reflecting on the emotive experience of the therapist during the therapeutic encounter. We do r The Association for Family Therapy 2007. Published by Blackwell Publishing,

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