When parents come to us, they are often anxious and overwhelmed about their children, adolescents or young adults’ well-being and behaviour. They have worked hard and done their best with the resources and instincts that they have, and their child is still struggling. They may be feeling powerless and burnt out, so it is understandable that they want someone to “fix their child” while they get some work done or take a much needed break. It is not that they don’t care; rather they care so much that they are willing to acknowledge their need for help from a professional.
Although I believe in the role of individual therapy to support children, I think that we tend to overemphasize the power and influence of such helpers in the lives of young people. There seems to be a myth that individual therapists can work magic on their young clients through a weekly individual session behind closed doors to help them overcome eating disorders, addictions, emotional dysregulation, PTSD, depression, anxiety disorders, ADHD, BPD, self-harm, suicidality, relationship problems, academic difficulties, oppositionality etc.
Let’s face it – a mental health provider has limitations. A therapist who meets weekly with a young client is spending at most 1 hour with them out of 168 hours of the week, which is less than 0.6% of the time. In some cases, parents request that a therapist meet only bi-weekly with a client, which is only 1 hour out of 336 hours within that period of time, or 0.3%. And that therapist is not around to observe or support the individual in their many contexts, with their unique demands, stressors and triggers. Finally, that therapist can also not control the environment and relationships which are impacting their young client.
I do not want to suggest that the task is hopeless. However, I do want to emphasize that therapists can not do this on their own. It is for that reason that the traditional model of individual therapy is not sufficient for children, adolescents and transitional aged youth, and must involve parents. Sorry to say that parents may not be able to sit back while the therapist “operates” on their child – perhaps as they sip their well deserved latte at the Coffee shop next door or open their laptop to get that presentation for work completed. Effective treatment includes parents just as much, if not more, than with young clients. This has been demonstrated in research with multiple populations in different settings and for a variety of challenges, including within DBT, CBT, FBT and EFT. It has even been shown to be the case for young adults. Therapists need parents to be providing updates and observations to inform their treatment. They also need parents to validate, encourage, reinforce, coach, and challenge their children in order to follow through on the treatment between sessions. They may need parents themselves to make changes in how they cope, manage emotions, communicate, and deal with parenting and other stressors. And although parents have to accept that they can not “change” their children, they actually have considerable potential to influence and support their children now and for years to come.
Research has long demonstrated that the treatment of children, adolescents and transitional aged youth is more effective with parental interventions, and yet parents continue to ask for individual therapy alone for their children, and clinicians continue to provide such limited approaches. We can make more of a difference when we work together as teams of therapists and family members in order to create the best chance of success for clients and their families. And perhaps, by investing time and energy in their child’s treatment and recovery now, parents may experience the long term benefits of a healthier child and family, and more time for themselves and their goals.
References
Berry, K. R., Gliske, K., Schmidt, C., Ballard, J., Killian, M., & Fenkel, C. (2023). The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis. JMIR formative research, 7, e45305.
Bosworth, C., Watsford, C., Buckmaster, D., & Rickwood, D. (2024). Caregiver Involvement in Psychotherapy for Young People With Borderline Personality Disorder and Borderline Personality Disorder Features: A Systematic Review. Clinical psychology & psychotherapy, 31(6), e70027.
Carr, A. (2019). Family therapy and systemic interventions for child‐focused problems: The current evidence base. Journal of Family Therapy, 41(2), 153–213.
Hurley, J., Lawler, M., Bray, A., & Oeding-Erdel, N. (2020). Achieving therapeutic gains for regional youth with emergent mental health issues through parental family system-based groups: Findings from a qualitative study. The Australian journal of rural health, 28(2), 161–167.
Knatz Peck, S., Towne, T., Wierenga, C.E. et al. Temperament-based treatment for transitional aged youth with eating disorders: acceptability and initial efficacy of an intensive, multi-family, parent-involved treatment. J Eat Disord 9, 110 (2021).
Murray, S.B., S., Anderson, L.K., Cusack, A., Nakamura, R., Rockwell, R., Griffiths, S., Kaye, W.H (2015). Integrating Family-based Treatment and Dialectical Behaviour Therapy for Adolescent Bulimia Nervosa: Preliminary Outcomes of an Open Pilot Trial. Eating Disorders, 23 (3), 335-344.
Pine, A. E., Baumann, M. G., Modugno, G., & Compas, B. E. (2024). Parental Involvement in Adolescent Psychological Interventions: A Meta-analysis. Clinical child and family psychology review, 27(3), 1–20.