You, noted care consultant and mediator, and elder’s children, are moving through the session smoothly when, what seems to come out of nowhere, one sibling lashes out at another. Ouch! Where did that come from? Unless you were one of the five people on Earth who grew up without a bit of resentment towards your parents, siblings, or the family’s pet hamster (and those five people are lying), you know exactly where that came from. Family members, sitting in a room, discussing sensitive family-related issues? It feels like therapy, and we all know that during therapy it’s okay — expected — to reveal hidden and sometimes powerful emotions. Family therapy and care mediation have so much in common that both care consultants and their clientele often confuse one with the other. Care mediation suffers from the if it looks and quacks like a duck, it must be a duck syndrome. But care mediation is not family therapy.

First, the similarities. A care consultation session often includes family members of more than one generation and, nearly always, one or more siblings. Those present have been brought together to solve a problem that has proven intractable. One or two of those present may be the focus of that problem. Most participants have a history together, about which they have varying opinions and attitudes, and that history results in mixed emotions about each other. There are numerous alliances and conflicts among the members.

Now let’s look at the differences. The children are nearly always adults and are looking after the needs of their parents rather than the other way around. The client may not be present in the session. (As a family therapist, I often worked with children’s issues by working with only the parents—but that’s not typical.) The siblings don’t live together, lessening their need to get along with each other. While there may be significant cross-generational issues, everyone is a grown-up and may do as they wish — although the client may be (legally declared) incompetent to make certain decisions. Potential inheritance — money — is the tyrannosaurus rex in the room.

There’s one more major difference, and for the care mediator, it’s the one that counts. It’s the one you have to remember when a participant first confuses care mediation with family therapy, and unloads both barrels on someone in the session — maybe a sibling, maybe a parent, maybe you. Experience tells you that, once the congeniality force-field gets lowered for even a moment, the dung will hit the wind-powdered energy generator: factions among siblings and elders will pop-up so fast, and in such number, that you’ll need Deep Blue to keep tabs. If you’ve kept your wits about you, this difference will whisper in your ear that it’s time to hit the pause button before you and family fall down a rabbit-hole of such chaos that it would make Lewis Carroll renounce fantasy.

You’re going to have to jump through all the stages of, “Oh, hell!” — from denial to acceptance — in moments, because the only person that pause button works on is you. What you have to remember is that, in family therapy and care mediation, the goals are different. While, in family therapy, the “identified client” is nearly always a child who is misbehaving in some fashion — skipping school, disrupting classrooms, doing drugs, running away, and so on — the client is typically viewed by the family therapist as one who is “acting out” to take the heat off the real problem. For example, Johnny disrupts his school classes because, as long as he’s the problem his parents stop bickering and (in his mind) won’t get a divorce. The family therapist understands that Johnny won’t stop acting out until his parents’ marital issues are dealt with. Whether or not the marital issues are dealt with directly or by way of Johnny’s problems is based on the approach of the family therapist, but dealt with they must be if Johnny is going to change his behavior.

Hence, the goal of family therapy must always take into consideration that, since they must all live together, they need to get along well enough for that to continue. And to make that happen, your job as a family therapist may be to help them change the complex family dynamics.

In contrast, the care consultant’s job is not to be concerned with the family’s dynamics except in how it immediately interferes with the goal of setting up and maintaining care for the client. All the work in the session should be to that end. This does not mean that the care consultant can ignore family dynamics, or that a deep knowledge of family systems theory is unnecessary. It’s important to know what influences are present during the negotiations among family members. A 40-year-old adult child’s concerns may be as complex, indirect, and unconscious as is with the disruptive Johnny. However, in care consultation and mediation, your interest is in minimizing the focus on concerns that are disruptive rather than constructive to setting up care. Respectfully acknowledge those feelings, but do not let them take over the session.