Treating parent-adolescent conflict: Is acceptance the missing link for an integrative family therapy?

doi:10.1016/S1077-7229(04)80045-2

Cognitive and Behavioral Practice

Volume 11, Issue 3, Summer 2004, Pages 305-314

https://doi.org/10.1016/S1077-7229(04)80045-2 Get rights and content

Change-oriented strategies such as problem-solving/communication training (PS/CT) and parental behavior management training (BMT) have been used to treat parent-adolescent conflict. Although several studies have documented the efficacy of these approaches relative to wait-list control conditions, clinically significant improvements have not been achieved for the majority of adolescents with significant behavioral problems such as comorbid ADHD/ODD. A similar pattern of findings was observed in earlier studies examining couple relationships. Extending the focus and scope of traditional couple therapy to an acceptance-based integrative approach has led to impressive treatment improvements in that area. In a similar vein, we propose an integrative family therapy and suggest enhancing more traditional change-oriented approaches such as PS/CT and BMT by integrating acceptance strategies into a values-centered family therapy. We discuss the role of experiential avoidance and values orientation within a family context and present examples of techniques adapted from traditionally adult- and couple-focused therapies. Finally, we discuss the balancing and sequencing of acceptance and change techniques and offer suggestions for future research and practice.

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Previous studies have shown that this treatment improves parent-adolescent communication and emotion regulation (Murrell, Wilson, LaBorde, Drake, & Rogers, 2008), reduces parental psychological distress (Brown, Whittingham, Boyd, McKinlay, & Sofronoff, 2015: O’Brien & Murell, 2011), increase mindfulness, and reduces parental and adolescents conflict. ( Greco & Effert, 2004). The first and second experimental groups received PST and PCRT for 8 weekly sessions of 1 h, respectively (from May up to the end of July 2019).
The main purpose of this study was to compare the effectiveness of Clark and Acceptance and Commitment Therapy parenting training on improving the emotional-behavioral problems of the child with divorced single mothers. The present study was a semi-experimental, pre-test, post-test, and control group. The research population included divorced mothers referred to the psychology and counseling organization centers of the Mashhad, Iran, during May-July 2019. Among them, 66 parents with their children were selected and randomly assigned into two experimental and control groups. Parents with their children in all groups responded to the Achenbach Children's emotional-behavioral problems Questionnaire before intervention (pretest) and immediately after the intervention (posttest). The results showed that there was a significant difference in anxious/depressed and attention problems between parenting skills training based on the Clark approach and Parent-Child Relationship Training based on Acceptance and Commitment approach. The results indicated that training the mothers in two parenting skills training and Parent-Child Relationship Training approaches can improve the emotional-behavioral problems of the child with divorced single mothers. The parenting skills training approach was more effective than control and Parent-Child Relationship Training groups in anxious/depressed and attention problems variables. Finally, it’s possible to conclude that both parenting skills training and Parent-Child Relationship Training are useful interventions in improving the children's negative feelings and beliefs about their parents' divorce and their emotional-behavioral problems, and can also increase positive feelings and attitudes toward parents and their resilience, ultimately leading to increase their compatibility with parental divorce.
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Additionally, adolescents experience demands associated with establishing and maintaining relationships, social decision making, and the need to manage personal and interpersonal conflicts. Thus, it is not surprising that interpersonal, adaptation and emotional difficulties tend to increase during adolescence (Greco & Eifert, 2004; Vialle, Heaven, & Ciarrochi, 2007). Some therapeutic approaches have addressed the lack of interpersonal skills in adolescents, such as interpersonal psychotherapy (Mufson, Weissman, Moreau, & Garfinkel, 1999; Weissman, Markowitz, & Klerman, 2000; Young, Mufson, & Davies, 2006) and interpersonal problem-solving training (D'Zurilla & Goldfried, 1971; Spivack, Piatt, & Shure, 1976).
This parallel randomized controlled trial evaluated the effect of acceptance and commitment therapy (ACT) focused on repetitive negative thinking (RNT) versus a waitlist control (WLC) in improving interpersonal skills in adolescents with problems of social and school adaptation. Forty-two adolescents (11–17 years) agreed to participate. Participants were allocated through simple randomization to the intervention condition or the waitlist control condition. The intervention was a 3-session, group-based, RNT-focused ACT protocol. The primary outcome was the performance on a test of interpersonal skills (Interpersonal Conflict Resolution Assessment, ESCI). At posttreatment, repeated measures ANOVA showed that the intervention was efficacious in increasing overall interpersonal skills (d = 2.62), progress in values (d = 1.23), and reducing emotional symptoms (d = 0.98). No adverse events were found. A brief RNT-focused ACT intervention was highly efficacious in improving interpersonal skills and reducing emotional symptoms in adolescents.
The reciprocal relations between experiential avoidance and social anxiety among early adolescents: A prospective cohort study
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Moreover, a number of studies have conducted their analyses based on the premise that experiential avoidance is a causal factor for psychological problems (e.g., Epkins, 2016; Papachristou et al., 2018), or that it serves a mediating or moderating function (e.g., Gerhart et al., 2014; Kashdan et al., 2013; Panayiotou et al., 2014). However, Greco, Blackledge, Coyne, and Enreheich (2005) along with Greco and Eifert (2004) mentioned that experiential avoidance is a widely varying process that is learned early in life and is reinforced by the social-verbal community throughout the lifespan. Specifically, Ishizu, Shimoda, and Ohtsuki (2017) demonstrated the reciprocal relations between experiential avoidance and school stressors or the psychological stress response.
Empirical research studies have revealed the relations between experiential avoidance and the tendency to suffer from social anxiety among adult samples. In addition, interpersonal problems can be risk factors for mental health problems or maladjustment to school; however, the links have not been investigated among early adolescents. In this study, we examined the reciprocal relations between experiential avoidance and social anxiety tendency among junior high school students. The responses of 660 Japanese junior high school students (313 boys and 347 girls, seventh to ninth grade, aged 12–15 years) to the Japanese short version of the Avoidance and Fusion Questionnaire for Youth and the Japanese version of the Social Anxiety Scale for Adolescents were collected at three time-points with approximately four-month intervals between them. Cross-lagged path analyses revealed that a prior tendency for social anxiety tendency positively later affected a slight increase in experiential avoidance at each time-point. In contrast, experiential avoidance did not significantly predict a later social anxiety tendency at any time-points. Therefore, the findings indicate that a social anxiety tendency can be a risk factor for enhanced experiential avoidance among early adolescents. These results can provide useful information for designing prevention and intervention plans for acceptance and commitment therapy for youths.
Improving flexible parenting with Acceptance and Commitment Therapy: A case study
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A study by Brown, Whittingham, and Sofronoff (2015) positively correlated experiential avoidance with an ineffective parenting style. Parenting interventions in this context should therefore incorporate acceptance strategies in facing their discomfort with their child's behavior and defusion strategies to offset maladaptive parenting behaviors (Coyne & Wilson, 2004; Greco & Eifert, 2004; Simon & Verboon, 2016; Wahler, Rowinski, & Williams, 2008). This paper describes a case study in which ACT was applied to a mother's problems in interacting with her family.
This paper describes a case study of Acceptance and Commitment Therapy applied to the problems in a mother's interaction with her family. Acceptance and Commitment Therapy is implemented using metaphors and exercises in seven clinical sessions with the mother. Psychological flexibility, experiential avoidance, behavior control, acceptance of private events and coherence of valued actions were assessed. The Valued Living Questionnaire was also used. The results show a decrease in control and avoidance behavior. Both mother and son's acceptance and valued actions increased at the end of the treatment and were maintained at follow-up. The treatment established a flexible behavioral repertoire not only by the mother, who received direct intervention, but was also in her son's behavior. The effects of her treatment are reflected in her son, suggesting two-way psychological flexibility between mother and son.
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Available research suggests that BFI is the most effective approach to parenting interventions. However, it is worth exploring whether augmenting BFI with alternative approaches enhances their effects and increases retention rates within programs, particularly with those families that do not currently benefit from participation (Dumas, 2005; Greco & Eifert, 2004). Adding strategies that assist parents to deal with the thoughts and emotions that may act as barriers to building warmth and closeness in the parent–adolescent relationship and to the implementation of effective parenting strategies may enhance the outcomes for existing BFI interventions (Dumas, 2005).
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Treating parent-adolescent conflict: Is acceptance the missing link for an integrative family therapy?

Journal of the American Academy of Child and Adolescent Psychiatry

Cognitive and Behavioral Practice

Applied and Preventive Psychology

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Addictive Behaviors

Cognitive and Behavioral Practice

Cognitive and Behavioral Practice

Behavior Therapy

Cognitive and Behavioral Practice

Cognitive and Behavioral Practice

Behavior Therapy

Behavior Therapy

Behavior Therapy

Cognitive and Behavioral Practice

Family-based treatment: Psychosocial intervention for children and adolescents with attention deficit hyperactivity disorder

Paradoxical intention and recursive anxiety

Mindfulness training as a clinical intervention: A conceptual and empirical review

Clinical Psychology: Science and Practice

Psychotherapeutic metaphors

The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD

Journal of Consulting and Clinical Psychology

A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder

Journal of Consulting and Clinical Psychology

The developing person through the lifespan

Mediators of change in emotion-focused and problem-focused worksite stress management interventions

Journal of Occupational Health Psychology

The ecology of human development: Experiments by nature and design

The ecology of developmental processes

When things fall apart: Heart advice for difficult times

A child-focused intervention for coping with procedural pain: Are parent and nurse coaches necessary?

Journal of Pediatric Psychology

At the threshold: The developing adolescent

Sequential analysis of mother-adolescent interactions of ADHD, ADHD/ODD, and normal teenagers during neutral and conflict discussions

Journal of Abnormal Child Psychology

Impact of problemsolving communication training and generalization procedures on family conflict

Child and Family Behavior Therapy

Parent-adolescent conflict and relationship discord

Functional contextualism: A pragmatic philosophy for behavioral science

Creating a context of acceptance in child clinical and pediatric settings

Adolescent development in family contexts

Relationship enhancement versus a traditional approach to therapeutic/preventative/enrichment parent-adolescent programs

Journal of Consulting and Clinical Psychology

Adolescence: Its psychology and its relations to physiology, anthropology, sociology, sex, crime, religion, and education (Vols. 1, 2)

The impact of acceptance versus control rationales on pain tolerance

The Psychological Record

Finding the philosophical core: A review of Stephen C. Pepper's World Hypotheses

Journal of the Experimental Analysis of Behavior

Acceptance and change: Content and context in psychotherapy