The three wishes technique in mental health

What is it about?

The National Health Service (NHS; UK) offers initial screening appointments for children referred to Child and Adolescent Mental Health Services (CAMHS) to determine clinical need and assess risk. Conversation analysis was utilised on 28 video-recordings of these assessments, lasting approximately 90 minutes each with a multidisciplinary team. This paper focuses on the agenda setting strategies used to establish relevant goals with children and adolescents; specifically, the technique of offering ‘three wishes’. For example, “if you had three wishes, what would you like to make happen?” In cases where children initially volunteered an assessment-relevant wish, they tended not to articulate further wishes. Non-assessment-relevant wishes (i.e. fantasy wishes, such as being “rich”) were treated as insufficient, with many approaches used to realign establishing assessment relevant goals. Where responses were not institutionally relevant, practitioners undertook considerable discursive work to realign the focus of the three wishes task to assessment relevance. In these cases, the wish responses were treated as irrelevant and tended to be dismissed, rather than explored for further detail. Such work with the children’s contributions has implications for engaging children and child-centred practices.

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Why is it important?

Engaging children in mental health work is crucial for child-centred care with children and young people, and it is important to understand how therapeutic engagement strategies work in practice,