Clinical Considerations When Clients Have Children

This SCP blog by Zalewski, Goodman, Cole, and McLaughlin corresponds with a new Clinical Psychology: Science and Practice article titled, “Clinical Considerations when Treating Adults who are Parents.”

Flight attendants always instruct passengers to secure their own oxygen masks before assisting others. This simple practice reflects that parents can best help their children after ensuring their own well-being.  This basic principle applies to many aspects of parenthood.  With regard to mental health, adults who address their own mental health needs are likely to be better able to effectively care for others. Thus, practitioners who treat adults who are parents have accepted the obligation to help the adult in their care, and also have the important opportunity, by extension to help the children of those adults.

But is this assumption true? Indeed, how concerned for children’s well-being should practitioners working with adult clients be when those clients are parents? Are there steps that those practitioners can take in serving these clients that will also contribute to the well-being of the clients’ children?

Scope

Population-based studies indicate that anywhere from 17-30% of adults have a diagnosable mental disorder in the past year, that 33-67% of individuals receive some form of mental health treatment (Bijl et al., 2003, ), and that the majority of adults with a mental disorder are parents (Nicholson, Biebel, Katz-Leavy, & Williams, 2002).  These estimates suggest that a significant number of adults seeking psychotherapy are parents.

The Challenge

One challenge for both practitioner and parent is that evidence-based treatments for adults focus largely on adults’ thoughts, feelings, and behavior or their interpersonal difficulties in adult relationships.  Generally, their roles as parents are not the target of evidenced-based interventions for adults, despite a strong body of evidence that psychopathology interferes with the quality of parenting that children require for healthy development across the lifespan. Indeed, there is substantial variability in whether and how interventions address adults’ roles as parents and, by extension, the well-being of their children (Stein et al., 2014). Furthermore, most parenting interventions are not designed to accommodate adult psychopathology (Maliken & Katz, 2013), although this is changing (cf. Ammerman et al., 2015).

The shortage of models and treatment options that integrate the concerns of both adults and their children is rooted in a long-standing compartmentalization of adult and child mental health services; despite high rates of co-occurring psychopathology, parents and children rarely receive linked clinical care (Reiss, 2011).  Interventions that integrate mental health services for both adults and their children are effective and efficient for many families (Ammerman et al., 2013; Goodman & Garber, 2017).  However, they are far less available than individual treatment modalities targeting either adults or children.

Practitioners who treat adults who are parents have a clear, justified entry point for identifying, preventing, and treating their clients’ parenting problems and mental health problems in their clients’ children. However, there are no standards of care or guidelines for practitioners providing individual adult psychotherapy services to adults who are parents that address the parenting role, or screen and refer for caregiving quality and children’s mental health problems. As a result, clinicians may miss potentially strong and cost-effective opportunities for helping parents and preventing child mental disorders.

Do parents need to “secure their own oxygen masks” before securing their children’s?

Opportunity and Education

Our article, Clinical considerations for treating adults who are parents, summarizes evidence on psychopathology in parents and considers the opportunities that practitioners who treat adults who are parents have in helping families and preventing psychopathology in the next generation. We address common barriers that may interfere with practitioners’ ability to incorporate parenthood and the well-being of clients’ children into practice as well as ways to address those barriers. One such concern is that practitioner’s may lack necessary training and competency in assessing and working with child populations. In addition, a common barrier is that even if a practitioner knows of evidence-based interventions to recommend for families, these interventions may not be available in their communities.  We offer concrete examples of starting points to address these barriers. Specifically, we offer ideas for how to screen parenting quality and children’s well-being within the context of adult psychotherapy as a starting point to determine if a client’s children may be in need of referrals for additional services. Other resources for practitioners and parents are provided in order to fill potential service gaps within communities.

Our hope is that clinicians who treat adults who are parents begin to view themselves as a powerful tool toward preventing mental health issues in the next generation.  Children are the most vulnerable individuals in society and depend entirely on parents and other adults to provide the environments they need for healthy development.  A clinician who is treating a parent possesses a unique opportunity to intervene on behalf of a child.

Discussion Questions

  1. This article focuses on the various ways in which psychopathology in linked between parents and their children. Regarding clinical practice, why is it important that clinicians who treat adults who are parents be aware of the various mechanisms by which psychopathology is linked in parents and their children?
  2. In addition, this article highlights that it may be overly simplistic to assume that when psychopathology in parents improves via treatment, children will always benefit. What are additional factors to consider that may impact the relation between parental improvement and child development? What are other treatment approaches clinicians should consider for families in which parents have psychopathology?
  3. What are the various barriers to integrating the role of parenthood when treating adults who are parents?
  4. What are some initial steps clinicians can take to begin to take to incorporate the role of parenthood when treating adults who are parents?

Reference Article

Zalewski, M., Goodman, S. H., Cole, P. M., & McLaughlin, K. A. (2017). Clinical considerations when treating adults who are parents. Clinical Psychology: Science and Practice.

Author Bios

Dr. Maureen Zalewski is an assistant professor in psychology at the University of Oregon and a licensed clinical psychologist who trains and supervises students in dialectical behavior therapy (DBT). She conducts research on child development in the context of mothers who exhibit extreme emotion dysregulation, such as borderline personality disorder. Her lab is currently conducting a randomized control trial on preschooler development when mothers receive DBT, using a developmental psychopathology frame.

Dr. Sherryl Goodman is the Samuel Candler Dobbs Professor of Psychology at Emory University and a licensed clinical psychologist who focuses in developmental psychopathology. She is an internationally renowned expert on maternal depression and child development. She also examines evidence-based approaches to the prevention of transmission of depression from mothers to their children.

Dr. Pamela Cole is a professor at Pennsylvania State University and a licensed clinical psychologist, delivering and supervising mental health services at the Penn State Psychological Clinic’s Child and Adolescent Service. She is a developmental psychopathologist who specializes in measurement issues and studying young children’s emotion regulation in the context of various environmental risk factors.  She also studies how cultural influences impact the expression of emotions and regulation strategies during early development.

Dr. Katie McLaughlin is an associate professor at the University of Washington and a licensed clinical psychologist who focuses in developmental psychopathology. She studies how experiences of stress and adversity impact children’s development. Her lab specializes in understanding mechanisms linking experiences of stress to risk for mental health problems in children and adolescents.

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