Parenting Skills Training in Couple and Family Therapy
Parenting requires a vast array of skills to guide a child through the developmental stages of life. Countless parent-child interactional sequences shape and inform a child’s perception of self, others, and the world. Parents can face a multitude of challenges as they attempt to establish the rules, roles, customs, beliefs, and values that shape the context of family life. When parents and children encounter obstacles, it can be helpful to seek out outside intervention and resources, such as parenting skills training, to assist in providing additional knowledge, skill building, and support. In cases of child abuse and/or neglect, parents may be required to attend parenting skills training or a specified evidence-based parenting program to ensure that parents or caregivers can provide their children with the safety and stability required by law (Child Welfare Information Gateway 2013).
Due to the vast array of training techniques and programs available, the focus of this discussion provides a broad overview of the development, rationale, and common characteristics of evidence-based parenting programs in general, rather than focusing on any one particular program. Utilizing an evidence-based parenting program (EBPP) is becoming a standard practice for many organizations seeking to provide quality, cost-effective, and efficacious services to the families they serve. EBPPs are attractive due to the ability to produce positive outcomes for families and assist in obtaining funding for services as well (Small and Mather 2009). Decades of research indicates that the participation in an evidence-based parenting program can have lasting positive impact on reducing disruptive or risky behavior in children and increasing the overall relational well-being for parents and children (Shaffer et al. 2001).
The development and application of parenting skills programs have shifted significantly over time. Though parenting programs vary in regard to targeted populations, length of service, delivery methodology, format, and setting, there are several core characteristics that assist in defining evidence-based parenting programs overall. Fundamental to all parenting programs is providing education to parents that promote the health, safety, and overall well-being of children and families. Programs aim to teach and collaborate with parents so that they can actively acquire parenting skills that reduce undesired or disruptive behaviors in children (Centers for Disease Control and Prevention 2009). Skill building for parents can focus on learning about the needs of children during specific developmental stages, practicing effective communication, learning alternative means of discipline, boundary or rule setting, and promoting the positive interactions between parents and children to support the parent-child relationship (Child Welfare Information Gateway 2013).
Programs generally consist of teaching and practicing standardized interventions or techniques that can be implemented across time, in a variety of settings, and across cultures. Common goals aim to increase cooperation and responsiveness in children, teach parents effective non-violent parent practices, and eliminate violence toward children (Haslam et al. 2016). To meet the specific needs of an identified population (e.g., young children 0–5, adolescents, and/or specified disorders such as ADHD, autism), it is vital that one becomes informed of the various EBPPs that are available and the appropriateness of fit for the family seeking services.
During the early to mid-1900s, governmental focus on child welfare regarding issues such as proper care, practices that led to abuse and/or neglect, and delinquent behavior supported practitioners’ and researchers’ efforts to create parenting programs that could assist families in creating safety and stability and reduce delinquency and risky behavior in children (Ponzetti 2015). The field of mental health has long acknowledged the significant impact parenting practices have in the development of abuse, neglect, mental and emotional disorders, and other risky behaviors. Thus, treatment models and structured parenting programs focused on parent education and alternative means of discipline practices.
Initially, parenting programs placed emphasis on the practitioner as an expert providing education and skill building through didactic methods. Just as the field of marriage and family challenged the view of the clinician as the expert, parenting programs have also followed suit. While programs continue to provide psychoeducation components, there is now an emphasis on a collaborative therapeutic alliance with parents to be co-creators of change (Hukkelberg and Ogden 2013). In the formation of parent training programs, two distinct approaches began to emerge, an approach that primarily focused on increasing the ability of a parent to elicit desirable behavioral responses from children and one that emphasized the promotion of the parent-child relational bond. Current meta-analysis research suggests that models that incorporate several aspects of both approaches produce more effective outcomes of enhanced parent-child interaction (Kaminski et al. 2008; Carr 2009).
Programs that focused primarily the behavioral component aimed to increase parental capabilities by providing psychoeducation and behavioral techniques (Shaffer et al. 2001). Behavioral parent skills training focused on changing parent and child behaviors through techniques derived from concepts of social learning theory. Clinicians educated parents about basic principles of reinforcement and trained parents to apply them in daily interactions with their children (Karpiak and Dishon 2016). Parents were instructed on how to implement positive and negative reinforcement strategies to shape their child’s behaviors. Positive reinforcement was used to increase desired behaviors. For example, if a child performs a protocol task, a parent could give him or her affirmation in the form of verbal praise. By focusing on and reinforcing positive behaviors from the child, the parent informs the child of the expected behavioral responses in a nurturing manner that can promote positive interaction and produce desired behavioral responses in the future (Karpiak and Dishon 2016). The intended goal is for the child to eventually perform expected behaviors without reinforcement. Clinicians also trained parents to accurately use negative reinforcement to decrease undesired behaviors. When a child performs a negative behavior, the parent was directed to remove a desired item or privilege from the child. This aimed to reduce negative behaviors like tantrums. The desired outcome of behavioral parent training was to provide parents with the skills to maximize positive and minimize negative behaviors in the child. Though outcomes of these programs demonstrated positive behavior modification for some, critics argued that more severe behavioral problems and the complexity of parent-child dynamics require models to consider contextual and relational factors that impact outcomes (Shaffer et al. 2001).
As a result, programs began to incorporate more interventions that target relational dynamics. Relational parent training intended to change the parent-child relationship because it has been found that parent and child behaviors are mutually reinforcing (Smith et al. 2013). A parent and child can become caught in a negative and reinforcing cycle consisting of non-compliance from the child and increasing demands from the parent. The interaction pattern escalates until it reaches a deadlock (Smith et al. 2013). Relational parent training aimed to interrupt the coercive and destructive cycle by teaching parents about the emotions underlying a child’s behaviors (Shaffer et al. 2001). Practitioners taught parents communication skills, like active listening, to increase their ability to relate to their child (Kaminski et al. 2008). Parents learned how to build a solid relationship with their children and how to support children with difficult behaviors.
As knowledge has increased, practitioners now understand the benefit of combining behavioral and relational methods to make parent training programs more effective (Kaminski et al. 2008). Unifying behavioral and relational parent training techniques allows practitioners to target a child’s negative behaviors from multiple perspectives. Relationship building and emotional communication skills complement the behavioral training component. Although the skills can be different, they are supplemental. For instance, a child may be more responsive to behavioral strategies, if the child feels emotionally validated by his or her parent.
Rationale for the Strategy or Intervention
Parents and children are dealing with complex issues arising from ever changing methods of parenting, the recent surge in technology, an increase in psychological disorders in children, and high expectations placed on parents to raise high-achieving children (Mahoney 2012; O’Keeffe and Clarke-Pearson 2011). Parents often seek resources and support in attempting to raise happy and healthy children, yet they can feel overwhelmed by the plethora of books, blogs, and advice from well-intentioned peers and family members. It can be difficult for parents and children to know how to respond to each other given the demands they experience on a daily basis. Parents are struggling to obtain knowledge about what effective parenting looks like. Parents may attempt to utilize interventions such as time-out or taking away privileges, but without proper technique, consistency, and follow-through, parents may be unsuccessful.
Limited knowledge about effective child-rearing approaches, combined with other stressors, like finances and family conflict, can lead parents to fall back on less desirable parenting techniques such as yelling, threatening, and spanking. Utilizing corporal punishment is not only damaging to the child, the parent-child relationship, and producing desired outcomes, but it also makes parents vulnerable to Child Protective Services intervention. In fact, in cases where parents utilize abusive methods, they are often required to fulfill a parenting education program as part of a structured case plan to regain custody of their children (Child Welfare Gateway 2013).
In addition, parents and children may not be adequately equipped to manage the rapid pace of technological advancement of the twenty-first century. Many children have access to Internet content via mobile phones, tablets, and computers, which may or may not be monitored by adult supervision (O’Keeffe and Clarke-Pearson 2011). Now, more than ever, children are being exposed to harmful information and content (e.g., pornography, cyberbullying, predators) that can negatively impact cognitive and emotional development. It can be difficult for parents to keep up with the level of supervision required to keep children safe on the Internet and know how to respond when exposure leads to harmful outcomes. The accessibility of the Internet and the pressure to allow children to have access to social media can place undue stress on parents to set and maintain limits for children. Parents need help in navigating this ever changing landscape of digital exposure so that they can learn how to have conversations with their children to address safety concerns. Furthermore, O’Keeffe and Clarke-Pearson (2011) pointed out that excessive social media use has the potential to decrease a child’s ability to self-regulate. Children are vulnerable to developing mental and emotional conditions, and parents need education and support to combat these risks.
Despite an increased knowledge and research about mental health, children continue to face a growing number of mental, emotional, and social issues. There has been an increase in mental health diagnoses in children, especially neurodevelopmental disorders and conduct disorders (Center for Disease Control and Prevention 2016), and experts continue to debate causality. Some researchers attribute the rise in childhood issues to the high demands placed on a child by adults (Mahoney and Vest 2012). There is a current push for children to be high achieving in academics and in extracurricular activities. Adults often promote the ideal child as being someone who is well-rounded in multiple areas. This can lead to overscheduling of activities, which has been shown to increase stress and anxiety in children already susceptible to psychopathology (Mahoney and Vest 2012). Parental success seems to be determined by the success of a child. Parents can spend large amounts of time, money, and other resources to maintain a child in extracurricular activities in the hope of boosting the child’s opportunities for success. Parents and children can both experience external and internal pressure to be successful, to “have it all,” and to have the appropriate responses even through the most difficult of times.
It is evident that parents and children are coping with a multitude of stressors. Therefore, it is imperative that researchers continue to develop parent training programs that extend beyond the parent-child relationship to increase support for families and incorporate multilevel systemic interventions (Carr 2009). Currently, several evidence-based parent programs offer a combination of behavioral and relational components, along with school-based interventions, community collaboration, and therapeutic family work (Kaminski et al. 2008). Capitalizing on the parenting component creates change within one system of a child’s life; however incorporating the other pieces of the child’s larger context can further increase positive results (Carr 2009). Children continue to spend a substantial time with their parents, but they are also embedded within other subsystems. Children encounter extended family members, coaches, scout leaders, religious clergy, and so many more people regularly. Supports need to be in place for a child to thrive in places beyond the therapy room and home. Parent participation in evidence-based parenting programs may go far beyond providing education but also in connecting families with multiple pillars of support.
Description of the Strategy or Intervention
A substantial amount of evidence-based parenting programs exist, and the number continues to grow as outcome data and new research emerge. Programs are developed and modified to respond to the various needs parents and children face throughout the life span. Though programs differ in terms of number of sessions, target age populations, delivery methods, and settings, programs must meet specific criteria to be considered empirical and efficacious (Assmussen 2012). First, programs undergo rigorous testing and ongoing evaluation to demonstrate how effective outcomes are to targeted populations. Participants of programs are evaluated via survey questionnaires and/or assessment at the onset of the program, during specified intervals, and at termination (Haslam et al. 2016). Organizations are also informed of the need to be a part of ongoing training, monitoring, and evaluation of outcome measures. Research demonstrates that effective parent training programs contain specific characteristics such as utilizing strengths-based approaches, family skills building, parent partnerships, trained and qualified staff, clear goals, and continuous evaluation (Child Welfare Information Gateway 2013). In addition, practitioners, in particular, need to be mindful of the added training, costs, and ongoing evaluation necessary to practice any particular parenting program.
To ensure program fidelity, evidence-based parenting programs follow standardized curriculum structures that detail specific interventions and practices that assist parents in the day-to-day interactions with their children. Common interventions or techniques can include implementing time-outs for both parents and children, boundary or limit setting, increased shared family time, family meetings, increased coping skills, personal strengths building, setting natural and logical consequences for undesirable behavior, learning effective communication skills, providing praise and encouragement, monitoring emotional responses for both parents and children, and increasing interactions that promote parent-child bonding, where a primary aim is to increase parent’s confidence and ability to raise their children in a loving supportive environment (Haslam et al. 2016). Parents are encouraged to ask questions, receive constructive feedback, and practice the interventions they have learned.
Just as curriculums are tailored to specific targeted populations, so are the varying forms of participant structure and delivery settings. Programs can be structured to work with parents one on one individually, in a group setting with other parents of similar criteria, and/or a blended structure where some sessions are held as a group and interactions with practitioners on an individual basis also occur. At the onset, participants are informed of their requirements for participation, the structure of the meetings or sessions, and where the meetings or sessions will be held. Parent programs can be held in an agency setting, community setting, and/or in-home setting. In-home settings, for example, may make it easier to accommodate to family schedules, practice interventions in the moment, build practitioner-parent collaboration, and assist in the completion of the program, where efforts are made to recruit, maintain engagement, and provide services that make it practical and desirable for parents to attend (Axford et al. 2012).
When deciding an evidence-based parenting program to participate in, parents and practitioners need to take into account the required number of sessions, location, and participant structure to ensure that the program meets the needs of the family and the parents have an increased ability to complete the parent program. Future directions of parenting programs must continue to evolve and take into consideration challenges such as accessibility of service to families, ongoing training and evaluation demands for practitioners, costs associated with implementation, and overall dissemination of programs to targeted populations (Shaffer et al. 2001).
Melissa (29) and George (31) have two children April (9 years old) and Andrew (5 years old). Melissa and George both work full time and believe that the demands and stress of their jobs have impacted the time they have for each other and for their children. Recently, they have been experiencing severe behavioral and academic problems with their daughter, April. During a parent-teacher conference, April’s teacher discusses how April’s inattention and aggression have increased. The teacher reports that April struggles with paying attention, following instructions, and completing assigned tasks and she has also started bullying peers in the class. The teacher reports that April is smart but that she is concerned that if left unattended, April’s academic performance and her social interactions with her peers will continue to suffer. During the meeting, Melissa and George acknowledge that they too have experienced difficulties at home. They struggle with getting April to complete her homework and to follow directions. They report that she either ignores commands or argues back resulting in yelling matches, tears, and frustration. The teacher recommends an evaluation and possible therapeutic support services to assist the family in responding to April’s behavioral challenges. The teacher provides Melissa and George with referral information for the school evaluation and suggests contacting the 2-1-1 information hotline to get information about local support services, such as family therapy and/or parenting classes, within the community.
Upon the recommendation of April’s teacher, Melissa reaches out to her local community-based counseling center for services. She finds a counseling center that provides family counseling and a parenting skills program called Triple P Positive Parenting (Turner et al. 2010). Melissa and George meet with a marriage and family therapist who is certified in the Triple P program, and they discuss ways in which the program may be beneficial to the family. The therapist also addresses any concerns and questions Melissa and George may have regarding their participation in the program. George expresses concern that he and Melissa will be judged by others as “bad parents,” but he also recognizes that April’s behavior is escalating quickly and that they may also have similar experiences as their son, Andrew, gets older. The therapist listens to George’s concerns and offers validation to both he and Melissa for making efforts to learn alternative ways that they may be able to respond to their children in a loving and nurturing manner.
Melissa acknowledges to the therapist that she has found it difficult to know how to respond to April’s acting-out behavior. She admits that she often gives in to April’s demands and is reluctant to use corporal punishment because she was spanked often as a child. George reports that he intervenes with punishment for April when Melissa asks for help but that he defers the majority of parenting responsibilities to Melissa. Both parents report that they are often tired and give in to the demands of their children because they feel guilty for having to work long hours. Melissa is tearful and George is noticeably upset regarding the situation. The therapist conducts an assessment of the family’s needs and their ability to actively participate in the Triple P program. Melissa and George are given details of the program and make a commitment to attend the 8-week course.
At the onset of the program, all parents in the group are given a workbook that outlines the topics that will be covered. They are informed that the program will include ongoing assessment, group meetings, and planned telephone calls with the therapist to tailor the program to each of the families’ needs. During the weekly sessions, Melissa and George learn that positive parenting involves finding opportunities to give praise for desired behavior, setting clear rules and expectations, and consistently giving clear calm instructions to their children. At home, Melissa and George make note of how they are trying to respond differently when April has an outburst. George reports that he is making more attempts to intervene when April is crying because she is frustrated with homework. Instead of getting frustrated himself, he remembers to look for April’s strengths and give her praise for her efforts. He is hopeful that his confidence and his relationship with April will get stronger as he learns more in the program. Melissa notes that she is trying to yell less and explain her expectations of April’s behavior more clearly. Melissa too is trying to praise April’s effort rather than expecting perfection.
All parents in the group are encouraged to find as many opportunities to practice the skills learned throughout the course. They are asked to share their experiences with the group and to provide details of successes and continued areas of growth. The therapist emphasizes that behavioral changes take time and consistent effort to see desired outcomes. She also discusses ways each parent can monitor his or her own emotional responses when problems in the family arise. Issues such as conflict, disobedience, miscommunication, and emotional outbursts are normalized as common occurrences in parent-child interactions, but parents are taught that these situations create opportunities to teach children appropriate responses.
Parents finish the Triple P program knowing that learning and implementing new skills take time, consistency, and trial and error. Melissa and George report to the therapist and to the group that they are making more efforts to notice positive qualities and interactions with their children but also in each other. Melissa acknowledges that though time to spend together continues to be limited, she and George are trying to work more as a team to respond to the kids in a different way and to appreciate the time they do have together. George admits that he was skeptical that the program would make a significant difference but he can see how conflict in the family has been reduced and is happy to report that April’s behavior is improving at school and at home.
- Assmussen, K. (2012). The evidence-based parenting practitioner’s handbook. New York: Routledge.Google Scholar
- Center for Disease Control and Prevention. (2016). Children’s mental health. Retrieved August 24, 2017, from https://www.cdc.gov/childrensmentalhealth/features/kf-childrens-mental-health-report.html
- Child Welfare Information Gateway. (2013). Parent education to strengthen families and reduce the risk of maltreatment. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.Google Scholar
- Haslam, D., Mejia, A., Sanders, M. R., & de Vries, P. J. (2016). Parenting programs. In J. M. Rey (Ed.), IACAPAP e-textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.Google Scholar
- Mahoney, J. L., & Vest, A. E. (2012). The over-scheduling hypothesis revisited: Intensity of organized activity participation during adolescence and young adult outcomes. Journal of Research on Adolescence, 22(3), 409–418. https://doi.org/10.1111/j.1532-7795.2012.00808.x CrossRefPubMedPubMedCentralGoogle Scholar
- Ponzetti, J. J. (2015). Evidence-based parenting education: A global perspective. New York: Routledge.Google Scholar
- Centers for Disease Control and Prevention. (2009). Parent training programs: insight for practitioners. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
- Small, S. A., & Mather, R. S. (2009). What works, Wisconsin evidence based parenting program directory. Madison: University of Wisconsin Madison/Extension.Google Scholar
- Smith, J. D., Dishion, T. J., Moore, K. J., Shaw, D. S., & Wilson, M. N. (2013). Effects of video feedback on early coercive parent–child interactions: The intervening role of caregivers’ relational schemas. Journal of Clinical Child & Adolescent Psychology, 42(3), 405–417. https://doi.org/10.1080/15374416.2013.777917 CrossRefGoogle Scholar
- Turner, K. M. T., Markie-Dadds, C., & Sanders, M. R. (2010). Facilitator’s manual for group Triple P (III ed.). Milton: Triple P International Pty. Ltd.Google Scholar