Behavioral Parent Training in Couple and Family Therapy
Name of the Strategy or Intervention
Behavioral Parent Training
Since its emerging presence in the late 1960s, behavioral parent training (BPT) has been one of the most widely used behavioral interventions for parents of children with behavioral problems. BPT involves clinicians helping parents to define behavior problems accurately, implementing assessment measures that further define the problem and its intensity, and educating parents in the treatment plans that would be appropriate for the problems within their individualized context (Briesmeister and Schaefer 1998). Although this approach has been applied to a variety of child behavioral problems, it is most commonly focused on antisocial behavior, including but not limited to noncompliance, temper tantrums, defiance, and aggressiveness (Serketich and Dumas 1996).
BPT is based upon the principles of behavior modification and social learning theory. A central component of BPT focuses on the role of parents and pinpoints how their actions are directly influencing the child’s targeted behavior. With the aid of a therapist, parents are to proceed with behavior modification techniques, oftentimes with rewards and punishments through the principles of operant conditioning during treatments. As illustrated by Chronis et al. (2004), parents are taught to identify and manipulate the antecedents and consequences of child behavior, target and monitor problematic behaviors, reward prosocial behavior through praise (e.g., praising a child for following orders), positive attention, and tangible rewards, and decrease unwanted behavior through planned ignoring (e.g., removing parental attention after child throws a tantrum), time out, and other nonphysical discipline techniques.
Rationale for the Strategy or Intervention
Under the umbrella of the social learning theory, BPT is a proponent of utilizing parents as mediators for childhood behavior problems. BPT especially emphasizes the role that parents play in the development and maintenance of undesired behaviors in children, and follows the assumptions that: (1) human development serves as a function between reinforcement and punishment, to which humans are constantly interacting with either one with the environment; (2) undesired – most often antisocial – behavior is learned and sustained by the positive and negative reinforcement children receive from social agents, most often parents; (3) the goal of therapy is to strengthen the desired behavior through positive parental reinforcement, while alleviating undesired behavioral through ignorance or parental punishment; (4) maintenance and generalization of treatment gains are heavily reliant on a process of positive reinforcement through a newly acquired interactive pattern based on BPT techniques (Dumas and Lechowicz 1989).
Notably, as caretakers, parents are most often the closest attachment figures for a child. Therefore, training an adult who has a greater and more frequent influence on the child to manage the presenting problematic behaviors will ultimately increase the likelihood that a positive change will occur. Furthermore, the involvement of parents is ideal because individual treatment usually does not address parental ability to deal with the child’s undesired behavior, adding additional distress that may be more effectively mitigated through a direct involvement of parental figures. Moreover, taking medication solely as the method of therapy also may not be sufficient enough to mitigate all behavioral problems. Lastly, due to a shortage of mental health practitioners that are thoroughly trained in working with children’s behavioral issues, training parents may be a more attractive option that can be both cost-effective and time-saving – a win-win situation for both clinicians and clients alike.
Description of the Strategy or Intervention
BPT treatments usually last for 8 to 12 sessions for 3 to 14 year olds, with the majority of treatment utilizing treatment manuals specifically describing the intervention while employing various interventions such as social skills training and school interventions (Chronis et al. 2004). In most cases, the training is delivered by a therapist and is conducted primarily with parents (as opposed with the child); however, the child could be involved in sessions during different periods of treatment.
BPT typically starts with a collaborative effort between the clinician and the parent(s) to assess for and provide an overview of the child’s presenting issues. The therapist may use this opportunity to psychoeducate, particularly in regard to concepts such as the social learning theory and the behavioral management principles, and how that could be tied into treatment. After mutually agreed upon treatment goals have been established, the therapist slowly starts to work behaviorally around different aspects of the child’s environment (mostly focusing on school and home). A clear reward system and response cost is then established to reinforce “good” behaviors and diminish “bad” ones. Oftentimes, a progress chart or a checklist of some sort is introduced and acted upon as in-session activities. The chart or list may pertain to identified desired behavior(s) of the child and tracking the progress of such behaviors on a daily basis.
Next, parents are trained to attend to appropriate behaviors and ignore inappropriate behaviors during sessions, while having the opportunity to practice and track their own success rates for administering the newly learned BPT at home. The therapist oversees and points out specific areas where parents can improve on (e.g., praising the child in a more effective manner) as parents recapitulate the weekly scenarios reflected back at home. Moreover, the therapist coaches parents to express more effective commands and reprimands to mediate the desired responses from the child. New rules are established, enforced, and continually modified based on the child’s progress, and time-out procedures are often included in this process. Additional rules and planning for unforeseen misbehaviors outside of home may need to take into consideration. Problem solving techniques are introduced and discussed to foster effective communications and interactions between parents and child.
Oftentimes, BPT treatment programs also collaborate with the child’s teacher to track the child’s performance at school and link it to the reward system administering at home. Before termination, maintenance of progress is addressed to ensure the modified behaviors are continued post-treatment. Unanticipated roadblocks in the future are discussed and planned ahead in hope for parents to refrain from similar pre-treatment situations.
Angela and Howard brought in Hunter, a 10-year-old soon turning 11 Hispanic boy who has had trouble at home with defiant behaviors and an oppositional attitude. Angela, feeling helpless, mentioned dismally how Hunter’s grades at school had been dropping (from an A and B range student to C’s), and how his behaviors at home had “gotten out of control.” As the therapist continued to inquire what “out of control” entailed for the parents, Angela went about how Hunter constantly yelled and screamed at them whenever he didn’t “get his way.” When things got worse, Hunter would throw around items in the house and physically push and hit his parents (mostly Angela) and then directly go to crying. Hunter’s father, Howard, expressed how often he lost his temper because of Hunter’s unacceptable tantrums and would often scold him harshly which would bring about more crying from Hunter.
The therapist laid out a brief overview for the duration of the time the parents (and child) were in treatment and determined whether both parents were on board with the treatment plan. After both parents agreed, treatment officially began and the therapist started with a mixture of psychoeducation and therapeutic strategies, adding in frequent inquiries regarding the child’s specific issue surrounding different techniques assigned for each week. Due to an inflexible working schedule, Howard was sometimes not able to join for the sessions, in which case, Angela would solely work with the therapist with occasional involvement of Hunter.
In the beginning, the use of a progress chart was introduced that let Angela and Howard document the desired behaviors that Hunter performed (e.g., picking up his trash, read for 20 min before night) through putting “star stickers” next to the ones he successfully completed. The therapist then continued on with coaching the parents for effective ways to diminish Hunter’s screaming and crying. Through many roleplays, planning, and validation, the therapist was able to coach Angela to speak to Hunter in a clear, concise manner to ask him to stop the presenting “bad” behaviors. The therapist taught Angela to be consistent with her answers and to “persist on,” even when she confessed that “it is so easy to give in.” After constant encouragement, the therapist walked Angela through different scenarios in which she was expected to ignore Hunter’s unreasonable tantrums. Moreover, the therapist facilitated discussion between Angela and Howard to establish agreement around Hunter’s punishment.
Lastly, Angela and Howard were coached to practice praising in a more natural and direct manner. Through periodic evaluations, the parents were asked to assess their progress and modify or strengthen BPT in certain areas if needed. Overall, throughout the treatment period, both parents expressed seeing slight improvement from Hunter over the course of treatment. Angela noted Hunter became more compliant with her orders and felt there were fewer tantrums of higher severity in the last month or so of treatment. There were still some relapses here and there, but both Howard and Angela were much more confident at handling Howard’s defiant behaviors and better at administering effective communication to Hunter. Before termination, the therapist also provided space for discussion regarding post-treatment and refreshed all the techniques the parents had learned.
- Briesmeister, J. M., & Schaefer, C. E. (1998). Handbook of parent training. New York: Wiley.Google Scholar