Parents as Coaches: An Overview of Parent Involvement in Child Psychotherapy, by Jennifer Rodman, Ph.D.

By October 29, 2012Blog

As a child psychologist, I have the pleasure of helping youngsters manage their emotions and build adaptive coping behaviors, However, experience has shown me the value of working with parents as well, and in the course of my work, I have learned that involving parents in their child's treatment is, more often than not, essential to therapeutic progress, and is also one of the most rewarding aspects of child psychotherapy.

In order to appreciate the purpose of parent sessions, it is important to first understand the theoretical underpinnings of cognitive behavioral therapy (CBT). Cognitive behavioral psychology operates on the idea that our thoughts and behaviors are shaped by the situations that trigger behaviors (known as antecedents), as well the outcomes of our behavioral responses to these triggers. For example, if Johnny screams because his parents try to serve him pancakes for breakfast instead of eggs, the antecedent would be not getting his first breakfast choice, the behavior would be screaming, and if as a consequence of the morning cacophony his exasperated parents throw out the pancakes and cook him eggs, well, Johnny has just learned that screaming will get him what he wants and he will likely do it again when faced with the same situation. In other words, environmental conditions shape behaviors, and inevitably guardians are a foundation for their children's environment.

One common misconception that arises when parent sessions are requested as part of a child's treatment is that of bad parenting. This notion is inaccurate let alone unhelpful. While parenting behaviors may be involved in the maintenance of problem behaviors, often this influence is not only unintentional, but it results from the best intentions. For example, what good parent wouldn t want their child to eat a nourishing breakfast This thought might underlie the behavior of Johnny s parents, who in complying with his demands, unintentionally feed the problem (no pun intended). What good parent would not want to soothe their child who is crying because she is afraid of sleeping alone in her bed Soothing is wonderful parenting behavior, but if in addition to comforting words, this child's parents allow her to sleep with them, the parent s attempt at rescuing will actually send the message that escaping is the solution of choice rather than facing her fears.

Another misconception is to equate parent sessions with parent psychotherapy. While I encourage parents to seek their own treatment in circumstances in which this is deemed necessary, the focus of their child's treatment is on the child. As a therapist, my job is to guide adults in building the strongest foundation they can to produce adaptive behavior in their children. So if bringing out the best in children is like building a sturdy house, and the parents are the contractors managing this operation, I guide the contractors in choosing materials, and planning and implementing the skills that will lead them to parenting goals they wish to accomplish.

Regardless of the presenting concern, parent sessions generally entail the following components:

Psychoeducation about the emotional and behavioral problems of concern, including which factors typically lead to such issues in children, how they typically present, how they are being maintained, as well as typical strategies for targeting these behaviors.

Parent Training to manage their child's emotions and behaviors in a way that will logically lead to a decrease in symptoms of concern. It is important for parents to realize that such strategies might represent parenting behaviors that differ from how they were raised, or even how they approach parenting their other children. Parents may wonder why the child of concern requires special treatment when their other children do not. The truth is that every child presents with unique concerns. Parent training does not mean that what one was doing before was wrong. Rather, it means that the child's behavior needs to be approached in a specific way in order to appropriately address and manage symptoms.

Parents are trained in Coaching their children in using the coping skills learned in child sessions, such as techniques for relaxation or anger management. Just like practicing a musical instrument is critical for mastery, working on skills outside of the treatment session plays an important role in helping a child achieve therapy goals across a range of contexts, such as school and the playground, as well as the home environment.

While aspects of parent sessions for a variety of childhood disorders cannot be described in depth within the confines of this article, I will provide a brief outline for some common emotional and behavioral issues. For oppositional and defiant behaviors, parents are taught how to retrain their children to associate positive behaviors with positive consequences. The therapist thus often guides parents in establishing positive reward systems that are practical for the household, in learning how to interact with a child in a way that strengthens the parent-child relationship, and on setting limits, such as consistent consequences, in order to manage misbehavior. For anxiety disorders, parents are taught the very same coping skills that their children learn in session, and are instructed in how to serve as their child's coach through exercises in which they are gradually exposed to anxiety-provoking stimuli. In Autism Spectrum Disorders, the therapist may work with parents on creating visual strategies, such as schedules, visual prompts, social stories and visual communication systems, as well as guide the parents in practicing social skills with their children.

Across the board, the results of research studies consistently reveal that adding a parent component to treatment enhances the effectiveness of child psychotherapy in both short and long term. In addition, parent involvement helps promote generalization of the skills acquired across time and setting. Above all, rather than placing the onus on the child to improve his or her behavior, parent involvement sends the message to your child that we are working together as a team to make life easier and more enjoyable!

Jennifer Rodman, Ph.D. is a licensed clinical psychologist whose areas of specialization include Autism Spectrum Disorder and other developmental disabilities, behavior management, and anxiety disorders. She can be contacted at jennifer@brooklynletters.com or (347) 974-1106.

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