The Emotional and Mental Health Challenges of Parenthood - Calm Kid Central

Helping Kids with Worry, Anxiety and Stress - Professional

The Emotional and Mental Health Challenges of Parenthood

Those of us who work in child and youth mental health meet *parents* (for brevity I’ll use ‘parents’ throughout this article, but I’m referring of course to all primary caregivers, biological parents or not) every week who are struggling with parenting related negative emotions and experiences such as parental stress, guilt, fatigue, frustration, anxiety and overwhelm. There is also a plethora of academic and research literature documenting the existence of these experiences for parents.

For instance, many studies suggest that many or most parents experience worry and anxiety about their children’s well-being, safety, health, friendships, relationships, school performance, behaviour, and life choices.  Parents also worry about the financial demands of parenting, their past parenting behaviours, and upcoming parenting decisions.

Surveys also find that many parents experience a high level of parenting related guilt, self-blame, or self-criticism. They feel guilty about getting angry, their children’s routines (e.g. time on technology is a common source of guilt), how much time they spend with their child and more intensely – about how their parenting might have contributed to children’s health, life or psychological challenges.  Sometimes this guilt/self–criticism morphs for parents into a more generalised sense of shame about their children’s behaviours or choices.

Other research finds that parents/caregivers experience a high level of mental/physical exhaustion and fatigue.  They feel there is simply more to do each day than they can manage and that they have no energy or resources to do the work of parenting.  One study found that 2 in 5 parents reported experiencing extremely high levels of fatigue/exhaustion which then impacted on their perceived ability to parent.

There have also been numerous studies on parental irritability, anger, and frustration.  While traditionally research on parental anger has been done through the lens of its impacts on children, recently more articles have focused on the aversive nature of feeling chronically irritated and angry for parents themselves.  In the popular media there has seemed to be a special interest in the challenges that experiencing anger brings for mothers (google “postpartum rage” and “mum rage”).

There are also a number of studies on parent chronic sorrow or grief – this has often been researched in the context of parents with children with disabilities, disorders, serious mental health conditions or significant life challenges (e.g. drug and alcohol use).  Another area of research considers parental grief (although of course of an entirely different level of intensity) which occurs when children leave home (or when there are long term ruptures in relationships).

Many studies have investigated the experience of low parenting self-efficacy, when parents believe they simply do not have the skills, abilities or knowledge to effectively parent, influence their child, or manage tasks related to parenting.  Some writers assert that low parenting self-efficacy is one aspect of parental depression. Studies also consider parental loneliness or sense of isolation, whereby parents report being cut off from social supports, due to lack of time, resources or energy.

Many studies show that parents who experience one type of negative parenting psychological experience are more likely to experience another type of negative parenting emotion, and also to have poorer emotional and mental health in general.  For example, studies have indicated that parents who have higher levels of parental guilt have higher levels of depression, that parents who report lower levels of parental confidence are more likely to report higher levels of mental exhaustion, that parents who experience higher levels of social isolation are more likely to experience higher levels of parental anxiety and so on.

Given the clustering of these experiences, some psychologists have attempted to create unified models linking negative parenting experiences together.  For instance, many researchers have written about the concept of parenting stress.  Deater-Deckard defined parenting stress as aversive psychological reactions to the task demands of parenting challenges in the parent-child relationship, and the child’s psychosocial adjustment.

Other writers have discussed the concept of parental burnout – although traditionally thought of in a workplace setting, this concept has now been applied to parenthood.  Parental burnout has been defined as the experience of three factors:  mental/physical exhaustion, low parenting self-efficacy and the experience of “distancing self from child/young person”.   One study concluded that using a parental burnout questionnaire finds between 40-60% of parents as meeting the criteria for being a ‘burnt out’ parent (which seems to me to suggest the concept skirts the edges of being a normal parenting experience).

While this all sounds pretty grim (incidentally, apologies to any first time expectant parents I assume are reading this article with dismay), there is also more cheerful research which I think is also worth noting here: that is studies which compare the incidence of positive emotions in parents compared to non-parents.  Many of these studies suggest that on average, parents often experience more positive daily emotions (for example, sense of meaning, love, pride, and joy) than non-parents.

This leads us to the “mixed bag theory” of parenting which suggests that parenting brings both more negative and positive emotional states compared to non-parenting.  This sounds pretty right to me – it seems that parenting – like many other life experiences (e.g. work, relationships) brings both the very good – and the very bad!

What factors are linked to higher levels of parental negative emotional experiences?

Those of us who work closely with parents know very well that not all parents suffer equally.  An interesting question is what specific factors might be linked to more frequent or intense negative parenting psychological experiences – in other words, what parents might be most at risk for high parenting related distress?

The research suggests there are a range of factors which might be associated with higher parenting distress.  They include the following:

  • Societal/community factors – for instance, some studies suggest when parents have greater financial challenges, and less social support – they will experience higher levels of parenting related distress.
  • Psychological parent factors – it seems parents with lower confidence in their skills, with poorer reflective skills (ability to notice their and their child’s emotions and the impacts of these on behaviours), who have less self-compassion, and other mental health diagnoses may experience more distress than other parents.
  • Gender of the parent – Several of the studies I’ve read report that more mothers experience more parenting distress (and parental burnout) than fathers.  It is worth noting however that many studies exclude fathers altogether.  I also wonder whether mothers are more likely to be willing to report parenting distress than fathers.  However, these caveats aside, it seems mothers are particularly at risk for parenting distress compared to fathers (and there of course I’m sure we can all identify plausible theories – related to the amount of parenting care provided, the amount of daily social contact, societal expectations just to name a few – as to why that might be the case)
  • Age of the child – there appears to be contradictory findings as to whether having younger or older children is linked with more parenting distress.  Many studies have found that parents/caregivers of younger children (especially under 5) experience higher levels of mental/physical fatigue for instance.  Other surveys have found however that parents are more likely to report parenting in the teen years to be more ‘challenging’ than parenting younger children.  Several studies suggest that parents of young adults seem to have lower levels of parenting stress overall – but only if those young adults have achieved some several life goals (having a job, moving out of home) – otherwise the parenting stress continues!
  • Number of children – there is little research on whether parents of more children are more distressed than those with less – but I did come across one study which suggested that the highest level of parenting stress is for parents with 2 to 3 children, with having four children not being more stressful than 3.  Having 5 or 6 children or more was linked with the highest level of stress, which I’m assuming is not a complete shock to many of us.

Parent emotional well-being when caring for a child with challenges

Despite the findings above indicating a number of parent and environment factors linked with higher parental distress, the most reliable – and definitely most investigated – factor linked with higher levels of parenting distress is the health and well-being of a parent’s children.  Specifically – parental distress is reliably highest in those parents with children with mental, emotional, physical health or life challenges.

Studies have documented this phenomenon for parents of children with many different types of challenges.  For example studies show higher than average levels of parental distress for parents of children with: ADHD; Autism; children with higher levels of challenging behaviours; anxiety disorders, intellectual disabilities; drug and alcohol problems; suicidality and depression; developmental disabilities; physical health challenges or disease (e.g. diabetes, cancer) and many other types of challenges.

I haven’t found any detailed studies which helps us make any firm conclusions about which of these disorders or challenges in children might lead to the highest level of stress in parents.  However, there have been some meta-analyses suggest that on average parents with children with externalising (challenging behaviours) might experience more stress than children with internalising symptoms such as anxiety.

Measurement of parental distress

There have been several instruments developed to measure parental distress.  These include the Parenting Stress Index (PSI) by Abidin and colleagues, the Parenting Daily Hassles Scale (PDHS) by Crnic and Greenber, the Parental Stress Scale (Berry & Jones, 1995), and the Parental Burnout Assessment (Roskam et al, 2018).  Many studies examining parental distress have also used other commonly used measures of more general adult mental health such as the DASS, K10 and others.

What are the implications of parental distress?

Parental distress is considered to be an important area of research not just because of the suffering experienced by parents, but because of its links with other important factors.  Below are three of the most commonly researched of these.

Links between parental distress and children’s well-being

Many studies have linked higher levels of parental negative psychological states to poorer mental health and functioning in the children of these parents.  For example, studies have documented relationships between: Higher parent anxiety and higher child anxiety; lower parental self-efficacy and more severe child behaviour problems; higher levels of parental depression and anxiety with higher levels of child impulsiveness and lower levels of concentration; higher levels of parental irritability/frustration with higher levels of child/youth irritability and frustration – and the list could probably go on for some time.  Some research has even documented higher levels of maternal stress in pregnancy with higher levels of anxiety and depression in their children many years later.

A simplistic reading of these research findings may be depressing and further guilt inducing (“my struggling is causing my child to suffer”) for any professional readers among us who are also parents.  Therefore, I want to pause here therefore and restate what we probably already know but may be important to be reminded of – there is an important difference between research which shows a relationship (correlation) and that which can show cause and effect.  Given researchers can’t deliberately induce parental stress in parents, every one of the studies described above can only ever show a link not a cause, and it is very possible that it is children’s poorer well-being which leads to increased parental distress (a very plausible theory) not the other way around.

It is also very plausible that there are ‘third factors’ which cause both higher levels of parental distress and higher levels of child distress/difficulties (genes/biological factors and a host of many possible shared environmental factors).

However, what is useful for us to note is that the relationship between parent distress and child challenges seems to be robust –if we come across a parent/caregiver with higher levels of parent distress, they are more likely that average to have a child with higher levels of emotional and mental health challenges too.

Links between parent stress and parental behaviours

Higher levels of parenting distress are also linked with unhelpful parenting behaviours.  For example, parents with higher parental distress are more likely to both use harsh parenting practices, to yell, use severe punishment, to (somewhat in contrast) use more permissive parenting strategies, do less monitoring of their children and to disengage with children more often.

Reread above the sentences on the distinction between correlation and causation and note that it is very possible again that it may be a range of third factors leading to both parental distress and unhelpful parenting behaviours – for instance, societal factors, relationship factors or factors related to more difficult child behaviours.

Links between parental stress and poorer response to child therapy

Interestingly for those of us who work with child mental health, the results of several studies have suggested that parents with worse emotional health or higher levels of parenting stress respond more poorly to therapeutic interventions aimed at treating children.  It is not overly surprising that this “higher distress-worse child therapy outcome” relationship has been found for parents in parent directed treatments (e.g., parent behavioural training and attachment orientated parent groups). We might expect that parents who are struggling might find it hard to engage with, apply or be helped by this type of therapy which relies solely on their input and engagement.

It is slightly more surprising that this “higher parental distress-worse child therapy outcome” relationship has also been found in some studies when looking at therapy for the child – in other words, highly distressed parents have children who are less likely to respond to child directed cognitive behaviour therapy, even if the highly distressed parent is not in the room.  There are absolutely some theories we can think of that can explain this, but the point is that parental distress may have – or at least be linked with – some far-reaching consequences.

Making parent distress real:  What does this look like?

I find that when I’m reading about psychotherapy research that I can slip into having quite a ‘distanced’ view of the suffering it describes.  In case you are the same, I thought it might be worth taking a moment to think about what the experience of parenting distress is really like in day to day for individual parents.

Fortunately, there have been many qualitative studies which have asked parents (usually parents with children with emotional/mental health and physical health challenges) to describe their parenting distress.  A selection of these is below, which I’ve included to give shape and form to this topic.

  • As I faced these difficulties with my children, and saw the parts most horrible of me, I got so scared and destabilized that I completely stopped feeling confident as a mother.
  • At times of crisis like that, I hate myself for not knowing how to manage.
  • I’ve been told that I’m a lazy parent. 
  • The stress of having a child like that on your relationship is massive and unfortunately a lot of relationships don’t survive it.
  • We’ve been child-free for one night in four years. No, there’s no one else who would dare to take on this problem.
  • (After the self-harm) I went away and cried hysterically.
  • And so that’s where I feel we’re unable to cope. So much with [the son] is really our own fault—we don’t know what to do.
  • There were a few good days, yes, but the rest was just anger and frustration combined with inexplicable crying and a sense of being overwhelmed. In the aftermath of those episodes, I’d feel horrible, like I’m a horrible mother, wife and person.
  • I’m going on to antidepressants at the end of the month because it’s just too stressful.
  • I feel powerless. I feel like I’ve lost this.
  • I try to be consistent, but at the same time I am alone, so it’s hard to be consistent all the time, because I just don’t have the energy.
  • We don’t go away on any trips. Occasionally we get invited to visit our parents’ homes or to have dinner with someone, but we generally don’t go. Because it is so stressful for him.
  • We feel that we have a child that requires monitoring twenty-four hours a day, in every situation.
  • Should I talk about how hard it is? It is so hard that I hear him in my mind every night as I get ready to go to bed.
  • Always being on duty, yes, and always being monitoring. Plus, the constant concern about what she was up to. Would she get through this day, or would she be taking an overdose? Would she be alive tomorrow? It’s that constant worry.
  • (I have) no private life at all; (my) whole life was committed to just taking care of (my) daughter.
  • Given that he was showing ADHD symptoms even as an infant, I became pretty old pretty quickly. Since he was born, I’ve always been old.
  • I judge myself, all the time saying to myself ‘wow, I did this wrong, and that wrong’, and it burdens me.
  • All the time there’s this feeling of guilt, that something went wrong during the pregnancy that made her the way she is today … It is something that is always there.

Treatment for parental distress
Moving on to some more positive news:  there are several psycho-social interventions which have been evaluated in the research literature as being helpful in reducing parental distress.

Although as you’ll see as you read through that there is a great deal of overlap as to the treatment components in each of these interventions, I think it is still useful for me to outline each of them separately so we can be familiar with the names of them.

Cognitive Behavioural Therapy (CBT) or Cognitive Behavioural Stress Management (CBSM)

CBT aims to help people see the links between their thoughts, feelings, and beliefs, to identify unhelpful or unhealthy ways of thinking, evaluate these to try to use more helpful ways of thinking, and to also behave in more helpful ways.  CBSM interventions use these CBT principles applied specifically to manage various life stressors (e.g. chronic illness and work-related stressors).  CBT for parenting distress and CBSM are almost identical treatments, and both have been applied to the reduction of parenting stress in a number of studies.

The treatment components of this approach usually include; psycho-education about distressing parenting related thoughts and feelings and behaviours and how they are linked to each other, identification of specific problematic or distressing parenting related thoughts/beliefs, evidence gathering/behavioural experiments to identify which of these thoughts/beliefs are inaccurate or unhelpful, identification of more accurate/helpful parenting related cognitions and beliefs, strategies to increase behaviours linked with more parenting related well-being (e.g. self-care strategies) and to decrease behaviours linked with more parenting related distress (i.e. rumination).

A number of studies have implemented a CBT or CBSM based program targeting parenting distress and all have been associated with reduced symptoms.

Mindfulness based parenting interventions

Mindfulness based parenting interventions aim to increase a parents ability to ‘mindfully’ and non-judgementally notice and kind acceptance of their own (and often their child’s) thoughts and feelings without unhelpfully reacting to them.

Mindfulness interventions include both “mindful parenting interventions” – in which the focus is predominantly on a parent using mindfulness with respect to the parent-child relationship and “mindfulness-based stress reduction for parent” – in which the focus is predominantly on using mindfulness to manage the parents own experience of stress.  Of course, many mindfulness programs are a combination of these.

The individual treatment components of mindfulness interventions usually include the following: Psycho-education about parenting stress and stress generally; psychoeducation about mindfulness and its potential benefits; introduction to and the practice of mindfulness – including exercises and home practice.

A 2019 review of 25 studies of parent mindfulness interventions (which were mostly for parents of primary aged children) indicated that mindfulness interventions for parents were associated with small to moderate immediate and maintained reductions in parenting stress compared to wait list control groups.

Parental reflective capacity or mentalization interventions

Parent reflective capacity (PRC) is defined as the ability of a parent to be aware of the thoughts, feelings, beliefs, and intentions of both them and their child – and to understand how this impacts on their behaviour and the behaviour of their child.  The concept of “mentalization” is closely linked to PRC and the terms have been used interchangeably.

Although the concept of PRC originally came from a psycho-analysis framework it has more recently been investigated as an independent construct with numbers of studies linking higher levels of PRC to greater child and parent well-being.  Interventions (very often with mothers and infants, and traditionally with mothers with substance abuse challenges) have therefore been developed which explicitly aim to increase PRC.  These include Parent-infant psychotherapy, Minding the Baby, Families Frist program and Connecting and Reflecting Experience (CARE)).

These interventions usually include individual treatment components such as: Psycho-education about the importance of PRC; and the use of reflective questions/discussion to help parents be more aware of their (and their child’s) thoughts, emotions and the impact of these on behaviours.  As you can see, the components are similar to those used within mindfulness interventions (although possibly with a stronger focus on psycho-education and rehearsal of identification of the parent/child’s internal states).

A 2020 review of PRC or mentalization interventions for parents provided a somewhat mixed picture on their impact on parent mental health – with some studies showing positive improvements on parent distress and mental health – and other studies showing no improvement.

Acceptance and commitment therapy (ACT) interventions for parents

ACT approaches focus on the function and context of (in contrast to the content of) thoughts, feelings, and sensations.  ACT supports people to see their internal psychological experiences as not harmful to them, and to accept them and focus on acting in ways which are important to them, regardless of the thoughts/feelings they are experiencing at any one time.  This in then is thought to improve ‘psychological flexibility’ (the ability to behave in ways which are helpful to self and others rather than be stuck in rigid, rule following, unhelpful ways)

ACT parenting interventions are accordingly designed to increase mindful and flexible parenting, and to increase a parents’ acceptance of the child’s and the parents own emotions and experiences.

Individual treatment components of ACT parenting interventions include: psychoeducation about parents’ internal negative parenting experiences/emotions as being normal, understandable, predictable and not harmful, using mindfulness exercises to increase acceptance of their own and their child’s emotional experiences, using defusion exercises (ways to see thoughts/feelings/beliefs in different contexts and therefore to ‘step back’ from these), using self-as-context exercises (seeing themselves and their children as more than the thoughts/feelings/beliefs they experience), and exercises to identify values and increase committed action (similar to behavioural activation).

A 2020 review of 27 ACT parenting interventions reported improvements in parent reported measures such as stress, depression, and anxiety.

Self-compassion interventions for parents

Self-compassion is defined as perceiving our own challenges in understanding (including being aware of the normality of these challenges) and non-judgemental ways and acting kindly towards oneself.   A number of studies have found that higher levels of self-compassion in parents is related to lower levels of all three of the following – depression, harsh parenting and child behaviour problems.  As a result, there have been a number of interventions designed to increase self-compassion in parents.

Self-compassion interventions include treatment components such as: psycho-education about the normality (and common humanity) of parenting related distress, psycho-education about empathy towards the self, problem solving with respect to boundaries and self-care; mindfulness exercises and loving kindness/compassion meditations.

A 2019 review of 14 studies of self-compassion interventions concluded that they effectively reduce parent distress.

Problem solving skills training
Problem solving Skills Training (PSST) is designed to teach the skills involved in effective problem-solving.  PSST for parents is similarly designed to help parents to do effective problem solving and also build skills that address practical problems faced by caregivers.

Components of PSST include: Helping parents to specifically isolate different problems (rather than ruminating or worrying) and then identify potential solutions, identify costs and benefits to which actions should be taken, to act and then evaluate what happened.  Some PSST interventions for parents also include looking at the thoughts and feelings that occur when identifying solutions and actions.

A 2024 review of several studies of PSST for parents of children with chronic health conditions (and who had high parenting stress) found these interventions have a positive effect on stress and depression.

Parent-child relationship focussed interventions (attachment/emotion focussed)

There have been many psycho-social interventions designed to improve parent child relationship using principles of attachment, emotion acceptance and emotion coaching.  These include but are not limited to Child–parent psychotherapy, Circle of Security program, Attachment and Biobehavioural catch up and the Tuning into Kids program.

Although these programs have traditionally been viewed through the lens of increasing the strength of the parent-child relationship (and increasing child well-being) I’ve included them in this list of interventions for parent stress because not only do these treatments involve working directly with the parents thoughts, beliefs and behaviours (not the children), many of these programs have an explicit (and measured) desired outcome for improved parental well-being.

The treatment components of these interventions usually include: Helping parents to have a greater awareness of their own experiences of caregiving and how these have shaped their own instincts and emotions when caregiving, helping parents recognize when children are experiencing challenges and different difficult emotions; supporting parents to show empathy and acknowledgement of their child’s experiences; increase physical affection; increasing regular “child/young person led” time with children; supporting parents to do emotion coaching with children.

Many studies have found an increases in parental mental health/decreases in parental stress and increases in parental self-efficacy after the completion of these programs – but some of them failed to find any positive impact on these constructs.  Given the uneven results, one recent review suggested that these programs may be more likely to improve parental responsivity rather than parent mental health, but more research is needed.

Collaborative Problem Solving

Collaborative Problem Solving posits that children’s challenging behaviour occurs when they do not have the capacity or skills to respond to expectations or demands, rather than due to motivation or other more complex psychological processes such as disrupted attachment.  CPS calls these failures to respond “unsolved problems” and suggests that parents to use a mediation/conversation process to discuss and problem solve how to manage those problems in the future.

Again, although the CPS intervention isn’t solely aimed at reducing parent distress, it is included here in this list of parent distress interventions as the main focus of the intervention is shifting parent understanding and behaviours rather than working directly with the child – and furthermore many of the studies of CPS measure parent stress outcomes.

The typical components of CPS interventions include: psychoeducation about the cause of challenging behaviour in children being related to skill gaps, supporting parents to assess the different types of skill gaps children might have, helping parents to reduce the use of rewards/consequences, helping parents to implement regular problem solving/mediation conversational processes.

Although there appears to be slightly fewer RCTS examining CPS compared to some of the other interventions outlined above here, several of the handful of studies which have been conducted on CPS found that the intervention does lead to reduction in parent stress.

Parent management training (PMT)

Parent management training (sometimes called Behavioural parent training) interventions are those which focus on supporting parents to more effectively use social/behavioural learning strategies to support their children’s use of positive behaviours.  These strategies include more effective instructions, use of praise, more effective monitoring of children, positive time with children, use of routines, use of negative consequences – and for adolescents – increasing autonomy supportive parenting and improving parent-adolescent communication and problem solving.  PMT programs are usually targeted at reducing children’s disruptive behaviours and are one of the most effective types of treatment for this presentation.

Again, given the person targeted for behaviour change in PMT is the parent and not the child, and given that most PMT program goals include the reduction of parent stress and increase in parental efficacy (which is often measured) these programs should be considered as a possible intervention for reducing parent distress.

Many studies have in fact found these programs are effective in reducing parental stress and depression, however other studies have failed to find an effect.

Some studies have looked at the effectiveness of adding “enhancements” to standardised PMT programs to target parent stress more directly – for example, adding problem solving components, stress management coping components; mindfulness components and relationship building components.

These studies have also had mixed findings – some found these added components are associated with accompanying further reductions in parent distress compared to standard PMT – and other studies failed to find any beneficial effects of adding these components.  Some studies found that additional components were additionally effective, but only for parents with higher levels of stress or depression.

What can we conclude from this research?

As you can see, the good news is that there have been hundreds of individual studies evaluating the effectiveness of individual interventions for parent stress and almost all of these find that all of the interventions above can be effective for many parents.

The bad news – and of course this is true of much of psychotherapy research – is that much of the research is subject to criticism.  For instance, very few studies use active control conditions (e.g. another form of therapy) leading to the possibility that improvements are due to expectancy effects.  In addition, many studies find relatively small or moderate effects, most do not assess whether these effects are sustained in the long term and of course there is the usual psychotherapy problems related to drop out and non-responders.

However, while we wait for the science to progress, I think the primary message we can take from the above literature that many parents will experience benefit from a course of psychotherapy which includes the above elements, and the accompanying reduction in parent distress may be extremely beneficial – for them, their children, and their parenting behaviours.

So, as always as clinicians – we forge on!

Practical applications – some ideas about working with parent distress in community settings.

A note to start – Determining who is the primary client.

Despite the fact some therapy approaches identify family groups as “the client “, and the Australian Psychological Society code of ethics which allow for having multiple clients most of us in Australia work under funding body and legislative guidelines which require us to identify one individual as our client.
This means, if we are psychologists/mental health workers working with children, even though we will frequently hear about parental distress from the parents of the children we work with, and will be supportive of them  – and possibly even have ‘parent only’ sessions to provide them with child/parenting issues psycho-education and parent strategies  – we always need to keep in mind that the parent is not our primary client.

Therefore, we need to ensure that the aim of whatever parent support and work we are doing is to first and foremost to support and provide therapy to their child – even if the child is not in the room at the time.  We apply all record keeping guidelines, funding body rules and other legislative guidelines with this understanding.

In contrast, there may be times when we are not working with a child client but instead directly with a parent/caregiver client to help them manage parenting related distress.  In this case, we will ensure the parent knows they are our primary client – and not their child.  We will apply all record keeping guidelines, funding body rules and other legislative guidelines on the basis that the parent is our primary client.  Importantly, due to potential conflict of interests, we would not usually see a child if we have seen their parent as a client, and not usually see a parent as a client when we have worked with the child. However, this would of course be an ethical question which needs to be examined on a case-by-case basis.

This differentiation – between working with a parent as the client (to reduce their parenting related distress) – and supporting a parent of our child client to improve child outcomes can sometimes feel artificial, trivial, or even unhelpful from a clinical perspective.

However, at other times, the distinction is clinically useful – it can keep us focused on the most important goals in either situation and on advocating for one individual in helpful ways.

In any case, whether we feel it is clinically helpful or not in any given situation –for many of us the distinction is nevertheless required by most of the funding bodies we work under.

The rest of this article will assume that we are working with a parent as the primary client, and I’ll outline a few ideas which might be helpful in applying the literature reviewed above to doing this work in community settings.

Assessment and identification of specific problems and goals within parent distress

There are several potential areas we might assess when we are working with a parent with high levels of parental distress.  Hopefully the brief synopsis of the parent distress literature outlined at the beginning of this article will have familiarized you with some of these – however, in case it is helpful to see this in list form here are some of the most common parenting distress related problems we might ask parents about:

  • Feelings of shame/guilt/excessive self-criticism
  • Experience of mental and physical fatigue/exhaustion
  • Unhelpful or excessive worrying behaviours or high level of anxiety about their child
  • Unhelpful or frequent/severe experiences of parenting related anger or frustration
  • Feelings of disappointment and sadness in their own parenting or in child/young person behaviours/life choices
  • Low confidence or perception of skill or ability as a parent
  • Feelings of or desire to be disconnected from children
  • Low sense of support for their parenting role from others (friends/partners/family)

For each of these areas of parenting distress, we will then of course assess:

  • External and internal triggers for these experiences
  • Frequency/severity of these experiences
  • Associated cognitions which are linked to these experiences
  • The potential causes of these psychological experiences (including early experiences, underlying beliefs) – and the parents’ views about causes
  • Behavioural consequences of these distressing experiences (including impact on their parenting behaviours)
  • Impact of these symptoms/experiences on social, occupational, and other areas of functioning.

It’s very likely parental distress will be accompanied by broader mental health challenges, including past trauma, other mental health diagnoses, past trauma, relationship difficulties, life challenges, social challenges, possible suicidality, and risk – just to name a few.

If we are only intending to treat the parenting distress and not the full scope of other potential mental health issues, it is important we do a full informed consent process prior to treatment so that the parent is aware of the limits and specific goals of the therapy work.  Even then, depending on our role, we may need to screen for these issues (initially and in an ongoing way) as well as have procedures to manage these issues as they arise (e.g. referrals to others for instance).

Treatment planning – possible intervention components for parental distress

Once we understand the key areas of parental distress which appear most important to address, we will need to think about the case formulation (causes and triggers for instance) and then start to identify treatment components which might be most helpful for the parent we are working with.

Hopefully this article has provided you with some possible useful treatment approaches for parenting distress.  In community settings of course, therapists usually don’t use one single manualized approach but instead take a person centred, transtheoretical approach in which they use treatment components from a variety of approaches are used depending on the need of the person.

Therefore, it might be helpful to have a ‘master list’ of the individual treatment components from all the evidence-based approaches for treating parent distress to select from or consider as you create your case formulation and treatment plan.  In case it is helpful, I’ve summarised in list form below most of the components of all the treatment approaches described above for parenting distress.  Please note this is not a comprehensive list!

  • Psycho-education about the links between parenting related distressing thoughts, feelings and behaviours
  • Psychoeducation about parents’ internal negative parenting experiences/emotions as being normal, understandable
  • Identification of problematic or distressing parenting related thoughts/beliefs
  • Evidence gathering/behavioural experiments to identify unhelpful parenting related thoughts/beliefs
  • Identification of more accurate/helpful parenting related cognitions and beliefs (including strength based cognitions and beliefs)
  • Behavioural strategies to reduce behaviours linked with parenting related distress
  • Behavioural strategies to increase behaviours related to self-care
  • Psycho-education about parenting stress and stress generally
  • Psychoeducation about mindfulness and its potential benefits
  • Exercises and home practice for mindfulness
  • Psycho-education about the importance of parental reflective capacity
  • Use of reflective questions/discussion to help parents be more aware of their (and their child’s) thoughts, emotions and the impact of these on behaviours
  • Defusion exercises (ways to see thoughts/feelings/beliefs in different contexts and therefore to ‘step back’ from these)
  • Self-as-context exercises (seeing themselves and their children as more than the thoughts/feelings/beliefs they experience)
  • Identification of parental and family values
  • Behavioural strategies to increase actions consistent with values
  • Psycho-education about empathy and self-compassion towards oneself
  • Setting up of boundaries and self-care activities
  • Loving kindness/compassion meditations
  • Helping parents to identify and operationalise parenting problems
  • Helping parents to identify potential solutions (and costs and benefits to each of these)
  • Helping parents to choose solutions and evaluate them
  • Increasing awareness of their own experiences of caregiving have shaped their parenting related emotions
  • Helping parents recognize when children are experiencing challenges and different difficult emotions
  • Use of social learning and behaviourally informed strategies to respond to their child’s challenging behaviours (e.g. effective instructions/use of praise etc)
  • Use of mediation/problem solving conversation with children
  • Helping parents to show empathy and acknowledgement of their child’s experiences
  • Helping parents increase physical affection
  • Helping parents to increase regular “child/young person led
  • Supporting parents to do emotion coaching with children
  • Psychoeducation about the normality of and causes of challenging behaviour in children (e.g. being related to skill gaps) and how this applies to their child/young person
  • Helping parents to implement regular problem solving/mediation conversational processes with their child

Relationship building/establishment of therapeutic alliance
Regardless of which treatment interventions (or their components) we use, like any therapy, much of the work with parents which is likely to be useful will occur through the building of a relationship with them.
Bordin’s therapeutic alliance model suggests we focus on a) bond/relationship and b) collaborative agreement.  Here are some thoughts about how this might be applied to working with parents with high parental distress.

Establishing a therapeutic bond/effective relationship with parents with high parental distress

There are many strategies we might use for establishing a strong bond between ourselves and parent clients.  Here are some of them:

Empathic exploration of distress – inviting parents to tell us about all the different types of parent distressing experiences they might have experienced, psycho-education about the normative nature of these experiences and sufficient in session time spent on listening and empathic responding (verbally and non-verbally) to the parent when they share these experiences with us.

Warmth and unconditional positive regard –providing our affirmation and appreciation of parent efforts and behaviours, discussion of and reflecting on the strengths (of their child and parent themselves), our verbal and nonverbal messages of warmth and positivity about ideas, comments, and experiences of the parent.

Authenticity – (appropriate and small) self-disclosure – I feel/I think/this happened to me/I have experienced, showing (genuine) emotional reactions to parents (verbal and nonverbal) in session.

Establishing a collaborative relationship

There are many strategies we might use to establish a collaborative partnership with a parent with high parenting distress, but these might include:

Operationalising and sharing parent distress reduction goals – this might mean talking with a parent about specifically what aspects of their parenting distress they want to work towards in therapy with us – for example, we might ask: What might it look like if you experienced less distress about parenting, and more moments of peace/satisfaction about parenting?  What parts of this would you most like to work on?

Discussion of home practice tasks and in session exercises – this might mean talking with a parent about the treatment components/at home tasks we are planning on introducing to them and asking them for feedback – for example, we might be asking questions like:  I’m wondering about if we planned to do X, Y and Z over the next X session – do you think this would be useful?  Do you have any other ideas?

Discussion of helpfulness of sessions/progress – this means talking with a parent about how they are finding the work/sessions, what has been helpful overall, whether they feel like they are making progress, whether there are aspects of what we have done or said which has been less helpful or more helpful.

In conclusion…

At the beginning of this article, I summarized all the ways in which some parents experience anxiety, sadness, grief, rage, exhaustion, and burnout related to their parenting journey.  When we consider the extent of this suffering, the difficulties many parents have in talking about this among their usual networks, as well as the well-established links between parental distress and child well-being, I feel this is an important area of work for all of us as mental health professionals.  It is one which has possibly long been overlooked.

If you would like supervision or support in your work with parents with parenting related distress, or would like to refer a parent to myself or one of our psychologists who supports parents with parenting related distress, please feel free to email our practice manager at [email protected].

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