One aspect of our clinic that parents, and even some clinicians, may find unusual is our requirement for parent attendance in therapy. We require parents to participate in every session for their child’s therapy appointments. The amount of time spent in the session could be a brief check-in regarding progress or attending the entire session. Typically speaking, the younger the child/lower the developmental level, the more time a parent spends in session; however, we do have some cases where the parent and older adolescent are together for the entire session. There are five main concerns I hear about our practice of involving parents. My hope is to address each concern to some degree and explain how our methods help most patients do better in therapy.

Parent Attendance in Therapy: Concerns Addressed

Concern 1: Therapy Without Parents Is More Effective

One of the most widely spread and easy-to-disprove myths in child therapy is therapy without parents is more effective. There is a growing body of evidence that involving parents in therapy can produce better results. This is true for children (Diamond & Josephson, 2005) and adolescents (Pine et al., 2024). Simply put, in most cases parent attendance in therapy results in faster, longer-lasting improvement than seeing the child alone.

There are several major reasons for this. Particularly for young children, parents can modify the environment in ways the child simply isn’t able to do. This could include advocating for services in the school, setting up adequate routines, or modifying parental behaviors, such as being more effective in using labeled praise.

Secondly, parents can play a large role in reinforcing skills taught in session. A lot of cognitive behavioral therapy involves psychoeducation and teaching positive coping skills. Parents who are taught these skills along with the child are better able to help the child with in-home practice when needed. This can be particularly true with instances when the child’s ability to make positive choices may be impaired due to a variety of factors (e.g., age, developmental level, current emotional status). Although we work hard to provide detailed handouts for many of the skills, parent retention is usually higher when they are present at the time the skill is taught.

The other reason for including parents is the relationship between the therapist and the child is not intended to be a life-long relationship. In many ways, I view any child/adolescent therapy case as a miniature family therapy case. By improving the system and helping the child learn how to access the resource of the parents, they may be more likely to do well long after I am gone. Finally, as a parent of adult children, I have learned parenting does not end when a child leaves home. Our aim is to help parents set themselves up for success to be there now and throughout adulthood.

Concern 2: What If the Parent Is the Problem?

In reality, it is fairly rare that the “fault” in a behavior is 100% on a parent. Regardless of training or experience, there is always something we can learn. As a parent of over 25 years who has been a psychologist for much of that time, I do not exclude myself from this. One of the great joys of this job is how I am still learning new things all the time. Although I do a lot of training for parents, a lot of the tricks on how to apply principles learned in school came from the creativity of past patients. The fun part of therapy is that learning is a two-way street.

Aside from this, there may be times when true deficits in parenting skills are present. In this situation, the therapist is limited without parental involvement. With few exceptions (e.g., abuse), getting new parents isn’t possible. The child will be in this environment at least until adulthood. Even then, cutting off “bad” parents can have large consequences (e.g., emotional, logistical, financial) that should be avoided whenever possible.

Parenting doesn’t come with an instruction manual. Yes, there are books out there, even about specific disorders. Applying this knowledge to your child sometimes takes the expertise of someone who devoted their career to these skills. Helping parents be better parents is a worthier solution than simply teaching children how to cope with bad parents.

You may ask “If the parent is the problem, why not just have the parent go to individual therapy?” The answer to this is kind of simple. One purpose in including a parent in therapy is to help the parent be a better parent to this specific child. We are not trying to solve the parent’s larger issues. We are just helping with a specific area of life. At times, parents may need individual therapy, but this is not always the case.

Concern 3: Parents Don’t Have Time to Attend Therapy Sessions

Some parents have difficulty making time to be involved in their child’s therapy session. Prior to being such a hardliner on this, parents dropped off their child to go shopping while the child was in therapy. There are even programs where therapists go into the school or the child attends virtual sessions from the school, removing the need for the parent to take off work during the day.

Although this may seem more convenient, my thought against this is twofold. First, your child’s mental well-being is worth the time. Second, there are many cases where you will save time in the long run by attending sessions with your child. Children can apply skills more quickly when parents give reminders. Parents can make helpful changes in strategies used at home to help the child (e.g., how to give commands, use labeled praise, or react to panic attacks). Children also retain skills faster with parent help. These advantages reduce the likelihood of having to return to services prematurely.  

When explaining my stance on parental involvement, I often say that I refuse to do “drop-them-off, pick-them-up therapy” because a kid is not a car that you can just “fix” and return to the parent. Even good pet training programs require the owner to be present at times to ensure training generalizes to the home environment.

Concern 4: The Child Will Be More Open Without the Parent

The concern that children may open up more without the parent is a valid one, but this is not always true. In practice, this has only been a minority of the cases we have seen in our office. When this happens, we may spend a larger portion of the session with the child alone. We then focus on brief parent check-ins and bring parents in during psychoeducation portions of the session. In many of these cases, one goal is helping the child learn to open up to parents when needed. This also includes working with parents on skills such as empathetic listening to help the child feel comfortable talking to them.

I have actually been surprised by the large number of patients who want their parent in the session. We even have a few cases where parents attend sessions with an adult child. This may be a one-time session or regular attendance. When the patient has a developmental disability, this is obviously helpful. Parent attendance can also be helpful when the young adult patient has anxiety and feels uncomfortable meeting with a stranger.

Concern 5: Attending Therapy Would Be Emotionally Difficult for the Parent

Requiring parent attendance in therapy may be difficult for some parents. It takes patience allowing the child to recount their view of family events that isn’t exactly as you remember it. Parents may find it difficult to talk about the last major conflict with the child without getting angry. I recommend having patience and trust in the therapist. We work with families all the time. We mean it when we say we don’t judge you harshly for what is happening at home. The worst things you deal with during the week are not usually incidents we think about after your session ends. Being able to help the parent and child manage the emotions around these events to solve problems effectively can be of great benefit. I often call these events “sandbox” moments. We use them to talk about larger principles that can be generalized to improve functioning.

Some of my most vivid memories of parents having difficulties with their own emotions are in cases where the child experienced abuse. Sometimes the child wants to talk to the parent about the abuse to receive support. Instead, the parent stops the child from talking about it. Sometimes it is simply because the parent has difficulty thinking about what their child went through. In other cases, the parent reports a lot of guilt for “letting” the abuse happen or not catching it sooner. In these instances, the best way to manage feelings of guilt is to do what you can now. Show your child they are not alone walking down the path of recovery.

If this is your situation as a parent, the largest advice I have is to be open with the therapist about your feelings. When this has happened, we worked toward developing open dialogue in session. At the hardest points, I have had parents step out of the room while I processed the most difficult emotions/events with the child. We then worked slowly to build up the parent’s tolerance to learn more as needed. A parent can be there emotionally without hearing a blow-by-blow account of all the bad things that happened to the child. Showing them you are working hard to be there for them shows a high level of commitment they will appreciate, even if it is too hard at the moment. In these more severe cases, I suggest parents seek individual therapy for themselves.

Parent Attendance in Therapy: Conclusion

Parent attendance in therapy can greatly enhance the process for the child. It helps with speed of learning skills and retention over time. Parent involvement also helps with making positive changes in family functioning. This can have a lasting impact on the parent-child relationship and overall functioning. It also empowers the parent as the primary source of help for the child, not the therapist. Furthermore, it helps build a system of support that can be helpful throughout the lifespan.

Post written by Dr. Gordon D. Lamb, Licensed Psychologist and Clinical Director

Please note posts are educational in nature and are not intended to replace psychological services when needed.

References

Diamond, G., & Josephson, A. (2005). Family-based treatment research: A 10-year update. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 872-887.

Pine, A. E., Baumann, M. G., Modugno, G., & Compas, B. E. (2024). Parental involvement in adolescent psychological interventions: A meta-analysis. Clinical Child and Family Psychology Review, 27, 1–20. https://doi.org/10.1007/s10567-024-00481-8