1. The Parallel Process The Parent’s Role in the Development and Growth of the Adolescent and the Family Our Experts: Tracy, Donna, & Cam Victoria Creighton, PsyD Cpsych Laura Mills, Ph.D. ( Q.M.Psych )

2. Introduction Youths Parents

3. Parents Story Tell us a little about what brought you to PRI What is your understanding of the parallel process? What is your child’s involvement in the family therapy

4. 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

5. Goal of the Parallel Process “For parents to regain their footing, learn and grow so they can meet their son or daughter with new awareness, insight, perspective and appreciation. The Parallel Process can also safe guard all the emotional work your child is doing in treatment by learning how to integrate these new skills into the family.” Krissy Pozatek

6. 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 whole family has to operate differently

7. Benefits For the Child: Sense of relief, Doesn’t feel like the “screw up” For the Parent: Feel more in control Long-term success

8. What gets in the way… Myths about Treatment The “Hand-em-Over” Myth The “Create-Your-Own Treatment” Blaming the other Parent Focus on the Child Focus on the Program Focus 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?

9. 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?

10. HOW? Dispel Myths Safety Life Story Parent Retreats Parent Workshops Multi-Family Groups Goal: Self Awareness Parents, what has been your experience with these processes? Was there one that stood out as a surprise?

11. Satir Family Therapy Why? Experiential Positive Involves the whole family Common Model

12. What Often Happens without the Parallel Process: Continuation of the Parent/Child Tangle Boundaries without Attunement Attunement without Boundaries No Container

13. 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?

14. Research Do Parental Skills Affect Youth Outcomes?

15. 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)

16. Technical Jargon – Simply Put Scores 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.

17. 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.

18. 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.

19. Internalizing Disorders 3-6 Months Post-PRI F(4,37) = 3.1, p=.028, R 2 =.25

20. Externalizing Disorders 1-2 Years Post-PRI F(4,34) = 4.8, p=.007, R 2 =.30

21. Substance Use: 3-6 Months Post-PRI F(4,46) = 4.3, p=.005, R 2 =.27 Substance Use: 1-2 Years Post-PRI F(4,35) = 5.3, p=.002, R 2 =.38

22. Summary We know there are some youth & program factors that predict outcomes ◦ Progression, age, sex, and mental health diagnoses When 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

23. Next Steps Look at clinician rating of parental engagement and it’s effect on completion & outcomes