The Use of Child Parent Relationship Therapy and Common Parent Concerns

Abstract

Play therapy and filial therapy methods have been shown to be effective for a variety of childhood issues. Filial therapy, especially child parent relationship therapy (CPRT), is also effective in reducing parental stress and improving the relationship between parent and child. Parents play an important role in a child’s well-being at home and are a vital part of a child’s involvement in counseling. In this review, we sought to identify best practices when working with parents during the CPRT process. In this article, we illustrate obstacles some parents may have to ongoing participation in treatment and solutions counselors might use to overcome these obstacles. Although these best practices are helpful for counselors using CPRT, we believe they are also helpful for counselors working with parents in many different settings.

Keywords

parent involvement CPRT parent needs counseling

In play therapy, counselors and other mental health professionals use toys and other creative media to work with children, in a developmentally appropriate manner, to help them overcome developmental, social, and emotional difficulties. The Association for Play Therapy (2009) specifically defines play therapy as “the systematic use of a theoretical model to establish interpersonal processes … using the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties…” (para. 1). Play therapy is used by counselors as an approach in which the counselor communicates with children at their developmental level using specific toys, arts, and games. Counselors, using play therapy, allow children to explore their feelings, increase positive interactions with others, and develop appropriate social skills using his or her natural form of communication (Kottman, 2003; Landreth, 2002).

Axline (1947) described specific tenets and beliefs of nondirective play therapy to be used with children who are listed on Rogers’ client-centered tenets and theory for working with adults. Nondirective play therapy tenets originated from the theoretical underpinnings and core values of Rogers’ (1951) client-centered therapy. According to Rogers (1957, p. 1), the client–counselor relationship is “necessary and sufficient” for client growth and to overcome unhealthy ways of being. Play is viewed as a child’s natural form of communication and can be used by the counselor to help the child grow and develop to his or her full potential (Kottman, 2001a; Landreth, 2002). Landreth encouraged counselors and play therapists to recognize play is a child’s language and toys are the child’s words.

Moustakas (1959) believed parents who provide a safe, trusting, accepting, and encouraging environment for a child to express their thoughts and feelings can create a growth-producing environment in which the child can adapt and change their thoughts and attitudes. Based on the ideas and tenets described by Moustakas and Rogers, the Guerneys created filial therapy as a method to help parents work effectively with their child to increase healthy communication and self-worth in the child. Filial therapy originated from Rogerian tenets and uses a group format to teach parents how to interact with their children using play therapy methods (Guerney, 1964).

One of the first models of filial therapy was used in the 1960s by Bernard and Louise Guerney. It was designed to be a long-term parenting program for parents of children with emotional and behavioral issues (Bratton, Ray, Rhine, & Jones, 2005; Landreth & Bratton, 2006). Guerney (1964) described the method of filial therapy as a play therapist engaged in teaching groups of 6–8 parents to interact with their children for weekly play times of 30–45 min. This process typically lasted 6 months to a year. During this time, the parent is taught to relate to the child using client-centered communication while learning to understand the therapeutic issue more clearly and avoiding punitive action toward the child. The goal of filial therapy thereby is to change the child’s perceptions about the parents’ feelings and beliefs about the child, to teach the child to communicate their thoughts and feelings to the parents, and to provide the child the opportunity to increase his perception of self-worth and confidence (Guerney, 1964). Filial therapy is commonly used with children between the ages of 3 and 10 years, although child-centered play times between parent and child can be adapted to “special times” rather than play times for adolescents (VanFleet, 2005, p. 2). Special times with adolescents only vary from play times in that the adolescent is allowed to select the activity or item around which the adolescent and parent interact.

In the 1980s, in response to a need for a more short-term, cost-efficient model, Garry Landreth adapted the Guerney’s model to a 10-week model (Guerney, 1964; Landreth, 2002; Landreth & Bratton, 2006). Landreth’s model has been refined and is now called child–parent relationship therapy (CPRT; Landreth & Bratton, 2006). In CPRT, parents are taught skills needed to become the therapeutic agent for their child (Deater-Deckard, 1998; Greenspan & Wieder, 2006; VanFleet, 2005). Those counselors interested in the use of the CPRT model can use the CPRT treatment manual that accompanies the textbook with specific instructions and guides for following the model along with printable parent materials and worksheets (Bratton, Landreth, Kellam, & Blackard, 2006).

The main focus of the CPRT model is to strengthen the parent–child relationship and create positive change within the relationship. Researchers have shown CPRT to be effective in reducing the level of parental stress, reducing problem behaviors in the child, and improving the parent–child relationship (Chapple, 2011; Landreth & Bratton, 2006; Sergeant, 2011). Counselors who use the CPRT model believe parents (and other significant caregivers such as teachers and extended family members) have the most significant and important impact on a child’s development (Landreth & Bratton, 2006). Past play therapy researchers have found that when the parent is involved in the counseling process, the positive impact is more prevalent than when the counselor provides the treatment without parents’ involvement (Bratton et al., 2005; Kottman, 2003; Landreth & Bratton, 2006).

The Use of CPRT

Notable researchers in the field of child counseling suggest that a child’s overall health is influenced by the level of positive interaction and involvement by the parent (Kottman, 2003; Landreth & Bratton, 2006; McGuire & McGuire, 2001). A child is able to learn skills and build relationships through healthy involvement and guidance by the parents. These researchers also recommend ongoing parent involvement in the play therapy process. This parental involvement in counseling leads to greater parental satisfaction in counseling process and a decrease in the child’s identified problem behaviors (Kottman, 2001b, 2003; Landreth & Bratton, 2006; McGuire & McGuire, 2001).

Traditionally, children are seen individually in play therapy, and counselors are encouraged to include parents through regular, ongoing parent consultations. Although traditional play therapy is very effective in resolving the presenting problems of many children and parents, other parents desire greater involvement in their children’s counseling along with new skills to help manage behaviors at home and school. CPRT, a form of filial therapy, was developed to provide counselors with another format for working with parents. Originally, filial therapy was developed by Bernard and Louise Guerney in the 1960s. Counselors use filial therapy as a way in which to help the parent strengthen the parent–child relationship while also teaching parents skills in which to help the child manage his or her behaviors. In essence, parents become the change agent in the child’s therapy rather than the counselor (Guerney, 1964; Landreth & Bratton, 2006). The overall goal of CPRT is to strengthen the parent–child relationship and create positive change within the relationship between parent and child.

Parents’ Needs When Participating in CPRT Sessions

Often, in the literature, parents’ perceptions and views of the effectiveness of various treatment models have been overlooked. Understanding parents’ views of their child’s treatment can be an invaluable resource for counselors and treatment providers. Parents play a vital and important role in their child’s counseling. Parents can provide counselors with information about changes, both positive and negative, outside the counseling sessions. In some treatment models, including CPRT, counselors work extensively with parents to create change in the parent–child relationship and therefore change within the child and his or her presenting problem. Recognizing what is helpful for parents and what might need to be adapted for a better fit when using CPRT can help the counselor provide effective and beneficial treatment designed specifically for that parent. In this article, we provide insight into 10 parents’ perceptions of the CPRT process and suggested adaptations from parents.

Much of the literature surrounding the effectiveness of CPRT has focused on its impact on the parent–child relationship and the changes in the child’s behaviors. Previous researchers have studied the impact of CPRT with mothers and children who have witnessed and/or experienced domestic violence (Smith & Landreth, 2003), nonoffending parents of children who have been sexually abused (West, 2010), parents of adopted children (Carnes-Holt, 2010), parents of children exhibiting disruptive behaviors (Moses, 2012), parents of children with high-functioning autism (Sullivan, 2011), and with parents desiring increased healthy family functioning (Cornett, 2012). Even with much of the literature exploring the effectiveness and usefulness of CPRT with many populations and issues, little has been done to explore the needs of parents including why they are interested in participation in a group, how parent goals are connected to the goals of the CPRT method, and specific needs that parents want to be addressed in the CPRT sessions. In a previous study, Bornsheuer-Boswell, Garza, and Watts (2013) used a qualitative phenomenological analysis of data that included conservative Christian parents’ perceptions of the CPRT process. In that study, the parent participants completed an intensive 5-week CPRT group and all accompanying activities. Some parent presenting issues included (a) relational difficulties between parent and child, (b) acting out and aggressive behavior toward the parent or siblings, (c) parents desiring a stronger relationship with the child, and (d) families experiencing divorce or separation. After the group, each parent participated in a personal interview regarding their views on parenting, the CPRT process, and the various elements of the group process. The parent participants found the CPRT group sessions were helpful in bringing about change in themselves, their children, and in the family system. The parents reported several techniques and skills which were noted as beneficial. These techniques and skills included the use of encouragement when communicating with the child, using statements rather than questions to understand and reflect the child’s needs, using the ACT limit-setting model (Landreth, 2002) when setting boundaries on behaviors, and remaining calm when the child began to escalate in inappropriate behaviors rather than escalating with the child (being a thermostat rather than a thermometer). Limit setting within the play therapy relationship can have significant impacts on the child but can be one of the most difficult skills for therapists and parents to use correctly (Landreth, 2002). The ACT limit-setting model, as described and developed by Garry Landreth, contains three basic steps. First, acknowledge the child’s feelings, desires, or wants through the use of an empathy-based statement such as Johnny, I can see that you are angry at me. Second, communicate the limit to the child with a statement similar to “You want to hit me with the block but I’m not for hitting.” Third, target alternative behaviors for the child with a statement such as “You can choose to hit or punch the Bobo.” Based on these findings and other research findings that address the impact of the CPRT process with parents, I compiled a list of best practices that play therapists and counselors working with parents and children may find helpful.

Identified Parent Needs During a CPRT Group

A majority of the themes that emerged from parent stories in past research focused on the compatibility of CPRT with specific parent beliefs, the relationship needs for parents and their children, and the desire to understand how the limit-setting model would be appropriate for different parenting styles (Bornsheuer-Boswell, Garza, & Watts, 2013; Edwards, Ladner, & White, 2007; Solis, Meyers, & Varjas, 2004). The themes also reflected the parents’ positive view of the skills and methods for communicating and helping their children learn in the group. Although the parents’ overall view of CPRT was positive, some expressed an initial hesitancy about the types of skills being taught and the underlying tenets and message being taught in CPRT (Bornsheuer-Boswell et al., 2013; Solis et al., 2004). Each of these areas highlighted by parents are discussed subsequently to help counselors and other mental health professionals become aware of the unique concerns and needs of parents who are seeking counseling services for themselves and their children.

Compatibility of CPRT and Parent Belief and Value System

A majority of the parents in the study by Bornsheuer-Boswell et al. (2013) reported compatibility between their beliefs and value system and the counseling modality were of utmost importance to them. The Conservative Christian parents reported commonly using Scripture as their guide in making decisions regarding their parenting skills and their interactions within the family. The parents stated CPRT allowed them a means in which to integrate biblical teaching and modeling with their children. This was the most significant theme from that research. The parents also noted that if the counseling modality was not a fit for them, they would not return for the following session. Previously, in 2011, Worthington, Hook, Davis, and McDaniel suggested that counselors should consider incorporating client’s religious and spiritual beliefs into the counseling sessions as requested or desired by the client. One method counselors might consider using is to include Scripture into the CPRT group sessions to help parents incorporate their new skills and knowledge into their religious and spiritual beliefs regarding relationship between parent and child. This has significant implications for counselors working with parents, especially when parents desire this compatibility with religious values. With a majority of persons and families in the United States noting that religion and spirituality play a key role in their day-to-day lives and family dynamics (Walsh, 2009), it is important that counselors recognize the importance of providing time and discussions around the ways in which the treatment model is a fit for parents’ belief and value systems around religion and parenting. For example, in their study, Bornsheuer-Boswell et al. (2013) found although some parents were hesitant about the effectiveness of limit setting, all of the parents were willing to attempt the skill. The CPRT facilitator provided ongoing and in-depth conversations about the purpose of the skill, how it was used, how it was a fit for the parent’s religious and parenting belief systems, and the benefits to the parent–child relationship and the resulting decrease in parental stress and problem behaviors. In the end, all parents in the study noted the limit-setting model was a helpful and effective strategy to use with their children and became easier to utilize as they, the parents, became more comfortable with the skill. This suggests that although previous researchers (Edwards et al., 2007; Solis et al., 2004) have indicated limit setting might not be a fit for Conservative Christian parents, the parents in this study group reported that it was appropriate and effective.

Walsh (2009) also stated that many people believe religion and family values and practices are closely tied together. She identified spirituality as being important to healthy family functioning, in that spiritual practices lead to greater connections between family members. Furthermore, Walsh established that people who regard religion as an important aspect of family life find that they feel closer to their families and experience increased feelings of job satisfaction, hopefulness, and optimism about the future.

In the CPRT sessions, this desire for compatibility may be played out in parents’ initial hesitation of what was going to be taught in the CPRT group. In a study on the inclusion of a biblically integrated CPRT research design, Waruszewski (2013) noted a positive trend in parents’ perceptions surrounding a decrease in parental stress and an increase in more healthy communication patterns within the family system. Waruszewski suggested that a brief, biblically infused CPRT may be appropriate and effective for parents who are seeking a treatment that matches their religious and spiritual beliefs. Parents were open to asking specific questions about what was going to happen throughout the sessions. The CPRT Parent Notebook, which each parent is given at the start of the group, contains information about the CPRT processes, so parents have an idea of different topics. The CPRT facilitator also discusses the group format and topics during the initial session. Parents are encouraged to discuss any concerns and what they want from the group during those initial sessions. When reviewing the dynamics of the group and the specific parent needs related to compatibility, a majority of the parents stated the skills taught and the overall message to the parents was a fit for both parents’ and child’s needs.

Parent Uncertainty About the CPRT Process

In the early sessions of some groups, parents may mention some hesitancy surrounding how to include various skills or homework assignments into the family routine because they are concerned that the children may not respond in the way they desired, that the changes would not be lasting, and whether the changes would be appropriate with their child’s specific issues. In research by Edwards, Ladner, and White (2007), one mother expressed concern that the limit setting and choice giving language was difficult for her and her child. To a large degree, parent’s hesitancy with the CPRT process encompasses the process, skills learned, and changes in the parent–child interaction styles. In a recent qualitative study about parents of children with autism and their experiences in a CPRT group, Sullivan (2011) reported that several parents were uncertain or struggled with different CPRT concepts that were taught or discussed within the group. Over the course of the 10-week group, parents began to integrate and understand the benefit of the skills and communication styles being taught by the counselor. Also, in reviewing the literature of parent perceptions of the CPRT skills, parents mentioned they were concerned whether the CPRT techniques would be an appropriate fit for their family, especially with respect to limit setting and discipline (Bornsheuer-Boswell et al., 2013; Edwards et al., 2007; McClung, 2007). Sullivan (2011) suggested this uncertainty may stem from parents’ previous knowledge or training in other parenting models that stress parent directedness and structuring of activities for the child. This is very different from the CPRT model in which the focus is on the parent allowing the child freedom and autonomy in making age-appropriate decisions, within a structured setting of the play time, which then lead to greater independence and problem-solving abilities.

Play therapists and counselors working with parents who display some hesitancy around developing and using these skills may benefit from the counselor spending additional time processing the parent concerns. Additional time during sessions or additional group sessions may be spent practicing the skills in session, so the parent feels comfortable with the skill and how to problem solve when the child does not follow through with how the parent perceives he or she should respond. Further, some parents may believe that if the skill does not work the first time, then they want to discard it for another. The use of encouragement when parents talk about their willingness to practice the skills at home or when a parent brings in a tape of them using the skill can help parents feel reassured that the skill is working. In the study by Bornsheuer-Boswell et al. (2013), one mother, Sharon, mentioned that the specific skills and techniques she was being trained to use were “something that’s completely brand new to us” (p. 85) but also stated that these skills and interactions provided “structure” (p. 97) to the family interactions with the children and facilitated expression of the values and skills she and her spouse wanted to model for their children. Similarly, another mother, Michelle, mentioned that using the CPRT methods were new and different but had positive outcomes. She stated:

Cause sometimes you can go through something, you’re still getting the same end result, but you’ve now taken a different approach to it and what the difference that made. So I’ve really like enjoyed that. The more, like, I learned about it and talked about it and put into practice, the easier that it’s gotten. (p. 85)

Kelly also agreed with this idea when she stated:

I thought it was really great. I got a lot of—I think we got a lot of new ideas that aren’t technically new but it shed a new light to us. We looked at it in a different way, we were able to understand it a little bit more, like with his praise and encouragement, he was able to understand the difference between them and how to do things better and how to do things to where we’re not belittling the child but empowering the child and I think that’s huge, too. As a parent you want to discipline and discipline and keep them structured and do all these things but you also are losing empowerment and giving them the decision to make those choices and feeling good about themselves so I think this kind of really helps you understand how to do that with your children. (p. 85)

Provision of New Skills and Increased Communication Through CPRT Group

One of the most significant themes that emerged across the literature was the reported helpfulness of the parent communication and interaction skills that were taught during the group (Bratton & Landreth, 1995; Ceballos, 2008; Chau & Landreth, 1997; Edwards et al., 2007; Garza, Kinsworthy, & Watts, 2009; Glazer-Waldman, Zimmerman, Landreth, & Norton, 1992; Glover & Landreth, 2000; Grskovic & Goetze, 2008; Kale, 1998; Kidron, 2003; Kinsworthy & Garza, 2010; Landreth & Lobaugh, 1998; Lee & Landreth, 2003; Solis et al., 2004; Sullivan, 2011). Parents overwhelmingly stated that the CPRT group had a positive influence on their interactions with their children and the issues faced by their children. All of the parents stated that the topics discussed in the group or individual parent sessions were valuable and needed. In surveying parents’ perceptions about what can be done to make the group discussion and skills taught in CPRT more appropriate to parent needs, Bornsheuer-Boswell et al. (2013) found none of the parents interviewed mentioned any significant changes to the topics or issues discussed although most parents suggested changes to the structure and location of the group that might benefit future groups of parents. Overall, the most helpful skills and techniques the parents found helpful were (a) using statements rather than questions to identify feelings and children’s needs, (b) being a thermostat rather than a thermometer (e.g., teaching parents to stay calm when the child escalates in intensity of behavior), (c) using encouragement rather than praise, and (d) using the limit-setting model and choices. One parent, interviewed during the study by Bornsheuer-Boswell et al. (2013), spoke about the helpfulness of the skills learned from the group, she mentioned:

The training does give you such a good outline. It gives you examples and give you steps of what you say and I really appreciate that, that it has a nice flow to it and I just think it’s a very valuable thing that I think a lot of parents could benefit from and it’s too bad that more that weren’t involved in it because it’s just really a very valuable process to learn. (p. 104)

At the same time, some parents have reported difficulty with the ACT limit-setting skill although they report that it is a helpful skill to learn. In a review of the research, most parents understood the utility of the ACT limit-setting model (Landreth, 2002) described in the CPRT manual and picked up the skill easily. This limit-setting model, created by Garry Landreth for working with children in child-centered play therapy and CPRT, helps parents focus on teaching their child how to manage his or her own behavior and the consequences of the behavior. The skill follows three steps (A) acknowledge the child’s feeling, (C) communicate the limit on the behavior, and (T) target an alternative behavior that the child could do instead. While some parents may easily understand and adopt this skill, some parents mentioned that, at the beginning, it was difficult to get all of the words out smoothly when communicating rules or choices, but the more they used and practiced the skill, the easier it was to say all three steps and communicate the appropriate choices (Bornsheuer-Boswell et al., 2013; Sullivan, 2011). Other parents have reported that they were able to use the skill during the CPRT process but were unsure whether they would adopt it later on (Edwards et al., 2007). In reviewing parents’ perceptions of the CPRT process, McClung (2007) noted that some parents, especially those who use corporal punishment, may need additional time and discussion about the limit-setting skill in order to become comfortable with it and understand the purpose of the skill. Sweeney, Homeyer, and Pavlishina (2000) reported parents who utilize behavior management to discipline their child may often encounter problems and noncompliance. Sweeney et al. suggested that filial therapy is an effective method for helping parents learn to discipline effectively and connect with their child through a strengthened relationship. Through the parent–child relationship, parents can reconnect with their child to help facilitate growth and change in the child; and this parent–child relationship is one of the most valued and respected part of the filial therapy process (Sweeney, Homeyer, & Pavlishina, 2000).

This clearly delineates that parents desire specific skills in order to help them better communicate with and mange problem behaviors with their children. Although parents desire the support and openness of speaking about general issues that all parents in the group experience, most parents report finding it helpful to learn and practice skills and techniques that allow the parents to work and communicate with their child more effectively. Furthermore, some parents may need additional support and guidance surrounding the use and implementation of some skills, most notably the use of the limit-setting skill. Counselors and play therapists should be aware of this need and be prepared to discuss parents’ views and beliefs about setting limits with children. In all, it is helpful for counselors and play therapists to recognize that parents find CPRT groups, and possibly other types of treatment groups, beneficial and most effective when parents perceive they have something tangible at the end of the day, something they can immediately go home and put into practice.

CPRT Group Logistics and Accessibility

Walsh (2009) reported many families are blended, formed with single parents, and have changing family and gender roles due to changing work habits, changes in the economy, and changes in the acceptance of various types of family development in society. Because of the changes in family roles, configuration, and dynamics, it is imperative that counselors find ways to meet the needs of the changing families in their communities. It is clear that parents in today’s society are pulled in many different directions due to work and family schedules and needs. Because of this, many parents are limited on time. This is reflected in the amount of time parents believe they have to give to counseling. Parents’ needs surrounding the balance of familial and work obligations and counseling have been minimally discussed in the play therapy literature. Recently, Bornsheuer-Boswell et al. (2013) explored parents’ needs around their desire to participate in counseling and also balance other obligations and family schedules. In their research, significant themes emerged related to parents’ ideas about the structure and logistics of the CPRT groups in making the groups more accessible and appropriate for today’s parents. These themes were focused on (a) duration of the groups, (b) location and small group setting, (c) child care during the groups, and (d) demonstrations during the groups and incorporating Scripture. Each of these areas of need was specifically identified by parents as important to beginning and following through with the treatment groups. It is important that counselors and play therapists recognize the obligations parents have and how it impacts the time parents have to dedicate to participation in groups and in practicing the skills at home. By doing so, counselors and play therapists will likely see an increase in parents desiring to participate in counseling groups and a decrease in attrition of group members. In the following sections, we describe the logistics of the groups and ways in which we made the group sessions accessible to parents.

Duration

The traditional 10-week CPRT group is typically the format for CPRT groups held in the community. In the study by Bornsheuer-Boswell et al. (2013) and in another by Kidron (2003), the traditional 10-week group was shortened to 5 weeks. The group format and information remained the same as the 10-week group. Instead of holding group sessions once a week, the sessions were held twice a week for 5 weeks. Kidron (2003) addressed the use of the CPRT model with a diverse population and successfully used a modified 5-week format for the CPRT group. Using this format, the researchers were able to condense all of the material that is taught in the traditional 10-week CPRT treatment model into a 5-week format. This was called an “intensive filial therapy” modification of the traditional CPRT model (Kidron, 2003, p. 42.). In Kidron’s results, she found no statistically significant difference in 10 weeks versus 5 weeks.

The 10 parent participants involved in the study by Bornsheuer-Boswell et al. (2013) were split on the amount of group time they perceived as the most beneficial. In their findings, half of the parents reported a desire for a 10-week group that met once a week, whereas the other half stated they preferred meeting twice a week for 5 weeks. In that study, one parent, Miley, suggested, “I mean I enjoyed it. I think you might get a better response if people came once-a-week instead of twice-a-week? I mean it wasn’t bad for me but I mean for all the rest of the people” (p. 116). This indicates that CPRT facilitators and those working with parents in the community should be aware of the time constraints that many parents have in today’s society. There are many logistics and obstacles that can keep parents from attending sessions or signing up for CPRT groups. These can include work schedules, children’s after-school activities, household tasks, traffic to and from the location, and even households with one car. All of these obstacles and many others can get in the way of providing services to parents who desire them.

Child care during CPRT group sessions

Again, related to parent’s needs for flexible times and schedules, parents might also need additional accommodations in order to participate in counseling. This might include a need for child care, especially when both parents are participating in groups. Due to limited finances or an inability to locate child care on their own, some parents who participated in the groups by Bornsheuer-Boswell et al. (2013) reported a need for child care if they were to participate in the CPRT groups. This is an important consideration that play therapists and counselors need to take into account when working with single parents or both parents during the group process. In their interviews, one mother, Michelle stated, “I really like that you did childcare if we needed it, because I actually needed it more than what I thought I would. Because, for a lot of people that determines whether or not you can come or not” (p. 119). Miley agreed with this and said, “I’m glad it worked out so that we could have the free childcare. It was awesome. I mean, you know, the truth is I probably wouldn’t have been able to do it for that so that was great and nice” (p. 119). Laura also described how conducting one session a week on Wednesdays was helpful for her and her family schedule when she said, “Wednesday was great because I knew that somebody was gonna be taking care of my children” (p. 107).

Discussion and Implications for Counselors

It is important to recognize the needs of parents involved in CPRT, other filial therapy models, and in play therapy. Without this awareness of parent needs and attention to these needs by counselors and play therapists, many parents may choose to drop out of services for themselves or for their children. Recognizing what is important to parents when they are seeking services and being able to address these needs helps parents stay engaged in the process. Understanding what is most helpful and effective for parents and also what outside obstacles parents may face in attending sessions may allow current and future counselors help parents stay engaged and open to mental health services. Past researchers indicated that parent involvement in the counseling process leads to greater satisfaction and outcomes in counseling (Bratton et al., 2005; Landreth & Bratton, 2006; McGuire & McGuire, 2001).

It is evident that when working with parents, counselors are encouraged to find ways in which the parents’ belief and value system can be incorporated into sessions. This can be done through the intake questionnaire in which a question is asked about the parents’ belief system and if they desire it to be incorporated into session (O’Grady & Richards, 2009; Watts, 2008). Previously, in McClung’s (2007) study, she noted some adaptations would be necessary for working with parents of religiously conservative populations in order that the parents feel comfortable and safe with the material and their belief system would be accepted and validated during the process. In the study by Bornsheuer-Boswell et al. (2013), the researchers found that holding the CPRT group sessions at a location that is within the community, such as a church, parents were afforded a feeling of being welcome and that their parenting and religious beliefs would be valued and respected by the group leader as well as the other parents during the CPRT process.

In the meta-analysis of play therapy effectiveness, Bratton, Ray, Rhine, and Jones (2005) reported that of the 67 studies involving parents using filial therapy methods, filial therapy demonstrated greater effectiveness than traditional play therapy methods. Landreth and Bratton (2006) then analyzed the meta-analysis data involving the use of CPRT. The results suggested CPRT was effective in all studies, and Landreth and Bratton found sufficient efficacy for the model including a large treatment effect. Additionally, qualitative analyses of parents’ perceptions and thoughts about CPRT effectiveness demonstrate that parents find the CPRT model to be beneficial in decreasing parent stress, improving the relationship between parent and child, and decreasing disruptive and problematic child behaviors (Bratton & Landreth, 1995; Ceballos, 2008; Garza et al., 2009; Grskovic & Goetze, 2008; Kale, 1998; Kidron, 2003; Kinsworthy & Garza, 2010; Landreth & Lobaugh, 1998; Lee & Landreth, 2003; Solis et al., 2004). Parents also reported specific skills taught in CPRT were beneficial. These included using statements when communicating between parent and child, being a thermometer (i.e., staying calm when the child is escalating), communicating encouragement to the child, and using limit setting and choice giving language (Bornsheuer-Boswell et al., 2013). In relation to the use of the limit-setting model, McClung (2007) indicated that adaptions to this part of the CPRT process may be required to make it applicable to specific populations. She suggested counselors should explain the use and benefits of limit setting and that, in the beginning, it be made specific to the play session. Author found when the topic of limit setting was discussed and practiced in a safe environment, the parents’ minds were not closed to the idea and they were willing to try it at home. Parents then became more open to using the skill during daily activities and subsequently obtained positive outcomes as a result.

Related to the CPRT group logistics and accessibility, parents suggested a variety of alternatives, including having sessions on a one weekday and one weekend day schedule each week, allowing the family more convenient time for other family activities and tasks during the other days. Overall, Bornsheuer-Boswell et al. (2013) found parents were open to and preferred small groups rather than larger groups, suggesting smaller groups allowed more time for discussion and learning the skills.

Finally, it is important that counselors and play therapists are aware of the cultural differences and issues of parents in their CPRT groups and address these issues accordingly. When counselors are not aware of the specific parent needs and issues, counselors run the risk of parents not feeling connected, their needs not being addressed, and the possibility of parents not continuing counseling services. We believe this article serves as a starting point for researchers to continue to explore the specific needs of parents who use counseling services for their children.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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