The Parallel ProcessThe Parent’s Role in the Development and Growth

of the Adolescent and the Family

Our Experts: Tracy, Donna, & CamVictoria Creighton, PsyD CpsychLaura Mills, Ph.D. (Q.M.Psych)

IntroductionYouthsParents

Parents StoryTell us a little about what brought you to PRIWhat is your understanding of the parallel

process?What is your child’s involvement in the family

therapy

What is the Parallel Process?

When parents engage therapeutically alongside their adolescent.

When Parents work to understand their OWN thoughts, feelings and behaviors

Learning to relate differently to their adolescent

The development of self knowledge

Goal of the Parallel Process

“For parents to regain their footing, learn and growso they can meet their son or daughter with newawareness, insight, perspective and appreciation.

The Parallel Process can also safe guard all theemotional work your child is doing in treatment bylearning how to integrate these new skills into the

family.” Krissy Pozatek

Need for the Parallel Process

Parenting is tough

We all have blindspots

Opportunity to open up and look at blindspots

For long-term success, the wholefamily has to operate differently

Benefits

For the Child: Sense of relief, Doesn’t feel like the “screw up”

For the Parent: Feel more in control

Long-term success

What gets in the way…

Myths about Treatment The “Hand-em-Over” Myth

The “Create-Your-Own Treatment”

Blaming the other ParentFocus on the Child

Focus on the ProgramFocus on the Future

Parents, what was one of the things that gets in your way?How did you prevent yourselves from falling into that trap?

The intent is not to blame parents for their child’s

problems, but to highlight negative patterns that many

fall into and empower parents to begin a new relationship

with their child.Parents – it’s easy to go into self blame. What was your process working

through that? How did you move beyond blame to actually doing the work?

HOW?

Dispel MythsSafety

Life StoryParent Retreats

Parent WorkshopsMulti-Family Groups

Goal: Self AwarenessParents, what has been your experience with these processes?

Was there one that stood out as a surprise?

Satir Family Therapy

Why?Experiential

PositiveInvolves the whole family

Common Model

What Often Happens without the Parallel Process:

Continuation of the Parent/Child Tangle

Boundaries without Attunement

Attunement without Boundaries

No Container

Parents who Have done their Work… Work to:

Create an environment where you they have: behavioral boundaries and expectations emotional attunement a culture of open communication and growth

Parents, what has this work been like for you?

ResearchDo Parental Skills Affect

Youth Outcomes?

Interested to see if higher levels of parental engagement & skills

predict better outcomes for youths

What Outcomes?◦Substance Use◦Externalizing Disorder Scores (CBCL; Achenbach 2003)

◦Internalizing Disorder Scores (CBCL; Achenbach 2003)

Technical Jargon – Simply PutScores that are different for different people are

called variables (they vary). Think weight.Some factors predict how much they vary from

person to person. Think height.A predictor accounts for a certain percentage of

variability on outcomes.The more variability accounted for, the stronger the

association between the predictor and the outcome.

More than one predictor might contribute to the variability. Think male/female.

First, we need to look at individual factors that might affect youth

outcomes

1. Therapeutic Progression (Stage):Further progression through therapy predicts lower his or her drug use Post-PRI and externalizing disorders at 3-6M.

2. Sex:Boys have higher rates of drug use Post-PRI than girls.

3. Age:Older youths have higher scores on internalizing disorders than younger youths at 3-6M Post-PRI but later Post-PRI age didn’t matter.

4. Number of Mental Health Diagnoses (incl. ADD/ADHD):

The more diagnoses a youth has at entry to PRI, the higher the internalizing disorder scores Post-PRI.

Put them all together with parental factors

Now, we want to see if parental factors make a difference on outcomes, even after you

account for the variability from the child / program factors that mattered.

We are ‘controlling’ for predictors we know influence youth outcomes.

Internalizing Disorders 3-6 Months Post-PRI

  B SE Beta t p

If all predictors = 0 -3.81 15.55 -0.24 0.81

Parental Attunement -1.80 0.94 -0.28 -1.91 0.06

Parental Limit Setting 0.59 1.21 0.07 0.49 0.63

Age 1.07 0.83 0.18 1.28 0.21

Number MH Diagnoses 2.35 1.02 0.34 2.30 0.03

F(4,37) = 3.1, p=.028, R2=.25

Externalizing Disorders 1-2 Years Post-PRI

BStd. Error

Beta t p

If all predictors = 0 2.44 9.17 0.27 0.79

Parental Attunement

-3.59 1.50 -0.39 -2.39 0.02

Parental Limit Setting

5.34 1.53 0.53 3.50 0.00

Stage at Departure 0.84 1.22 0.11 0.68 0.50F(4,34) = 4.8, p=.007, R2=.30

Substance Use: 3-6 Months Post-PRI

F(4,46) = 4.3, p=.005, R2=.27

  Beta SE ST Beta t pIf all predictors = 0 4.84 1.27 3.80 .00Stage at Departure -.30 .15 -.27 -2.01 .05

Sex .91 .46 .26 2.01 .05Parental Attunement -.38 .19 -.27 -2.00 .05

Parental Limit Setting -.14 .21 -.08 -.65 .52Substance Use: 1-2 Years Post-PRI  B SE Beta t pIf all predictors = 0 2.02 1.61 1.26 .22Stage at Departure -.61 .21 -.41 -2.89 .01Sex .39 .61 .09 .64 .53Parental Attunement -.04 .25 -.02 -.14 .89Parental Limit Setting .77 .25 .44 3.06 .00

F(4,35) = 5.3, p=.002, R2=.38

SummaryWe know there are some youth & program

factors that predict outcomes◦Progression, age, sex, and mental health

diagnosesWhen we account for these, parental

attunement and limit setting are significant predictors of youth outcomes

Recommend development of these skills for parents while youth are in treatment

Next StepsLook at clinician rating of parental

engagement and it’s effect on completion & outcomes