Читать книгу A Clinician's Guide to CBT for Children to Young Adults - Paul Stallard - Страница 18

Parents have a central role in supporting their child, and by involving them in the intervention important parental behaviours and contextual factors can be addressed. Their involvement can therefore facilitate generalisation, practice, and reinforcement of new skills in the young person’s everyday life. However, there is no consistent evidence to suggest that involving parents in CBT programmes results in better outcomes (Breinholst et al. 2012). For example, reviews have shown that CBT for anxiety is effective with and without parental involvement (Higa‐McMillan et al. 2016; Reynolds et al. 2012). Neither the age of the young person nor whether both parents are involved appears to be related to enhanced outcomes (Carnes et al. 2019; Manassis et al. 2014). Similarly, school‐based CBT anxiety prevention programmes have been found to be effective without any parental involvement (Stallard, Skryabina, et al. 2014). However, assessing the benefits of parental involvement is complex and the potential beneficial impact on parents or other family members has seldom been assessed (Breinholst et al. 2012). In addition, whilst the additional short‐term benefits may not be evident, parental involvement in CBT may support the longer‐term maintenance of treatment gains (Manassis et al. 2014).

There has been less research focusing on parental involvement in depression programmes. In a review, Oud et al. 2019 found that parental (caregiver) involvement may enhance outcomes compared to child‐only CBT. The way in which parents are involved in programmes has received limited attention and may explain some of the differences between studies. Stallard (2005) described four models of parental involvement: facilitator, co‐clinician, clinician, and co‐client. The most limited involvement is that of the facilitator where parents attend one or two review meetings with their child. The focus of the intervention is on the child’s problems, with parents receiving information about the intervention and the skills their child will be developing. As co‐clinicians, parents are more actively involved in treatment. They attend each session with their child, either for the whole session or joining for the last 15 minutes. The intervention remains focused on the child’s problems, but parents have greater awareness of the skills their child is acquiring and so can prompt and encourage generalisation. This role is further enhanced when parents are involved as clinicians. In this role parents are provided with the information and support required to teach their child CBT skills. Finally, parents may be involved as a co‐client. This model recognises that parents may be behaving in a way that contributes to their child’s problems. The intervention therefore helps the child to develop and practise skills to deal with their anxiety whilst parents learn new ways of encouraging and rewarding their child for facing their worries.

In summary, parental involvement needs to be considered on a case‐by‐case basis and a decision made about whether parental involvement may be beneficial and, if so, how parents/carers need to be involved (Carnes et al. 2019).