The Power of Positive Feedback in 10 Minutes!
A 10-minute segment of a session is sometimes enough to tell where the whole course of therapy is headed. This week’s study by Barnett and colleagues (2017) looked at the importance of differences in therapist behaviour during a 10-minute window of the first coaching session of a parenting program.
Parent Child Interaction Therapy (PCIT) is an empirically supported parent training program where therapists provide real-time direction and feedback to parents as they interact with their child in session. Therapy consists of 2 phases: 1) Child-Directed Interaction (CDI) where parents are taught to increase positive comments about their child’s behaviour while decreasing demands, accusations, commands and criticisms; and 2) Parent-Directed Interaction (PDI) where parents are taught to use age-appropriate discipline: giving effective commands and consistent responses to both compliance and noncompliance. Parents don’t “graduate” to phase 2 until they “pass” phase 1 by demonstrating a minimum number of positive interactions (praising the child, explaining why; describing the child’s appropriate behaviour, providing reflective statements in response to child statements) and a maximum number of negative interactions, within a 5-minute period.
PCIT identifies 3 kinds of coaching: 1) Directive coaching = prompting and telling the parent what to do (e.g., “Praise him for sharing”); 2) Responsive coaching = praising the parent’s behaviour; and 3) Constructive Criticism = correcting the parent’s behaviour (e.g., “Don’t ask questions”). The study was originally designed to predict treatment drop-out but they ended up having such a good retention rate that the study was somewhat underpowered to achieve this. Nice problem to have. Nevertheless, the authors sought to see whether particular therapist behaviours predicted: a) whether clients dropped out or completed treatment; and b) how quickly parents achieved mastery of phase 1 (CDI).
This study involved 16 therapists working with 51 parent-child dyads, who were referred either for distress about their child’s conduct or if the family was identified as at risk for physical abuse. Clients were all from a low-socioeconomic, predominantly Hispanic urban area of the USA.
There was a significant difference between those who completed and those who dropped out of treatment in the amount of therapist responsive coaching. Therapists offered more specific praise (explaining what the parent did well) to parents who completed treatment. The data do not demonstrate a causal effect and it’s likely that characteristics of the clients also contributed to this difference. Significantly, non-completers were also given a greater number of “drills”, where therapists suggest the parent focus on performing a single parenting skill as often as possible in a 1-minute segment. This likely indicates that these parents were struggling to learn the skills. Parents who completed treatment also appeared more skilful from the outset. Nevertheless, given that therapist can’t change the baseline characteristics of their clients, it pays to emulate the therapist behaviour that may have contributed to keeping the client in treatment. The degree to which therapists used specific praise in this 10-minute window of the first training session also predicted how quickly parents mastered child-directed interaction skills.
And there you have it, another thing I’m sure you would think you already do: provide specific praise. However, this goes out to those of us who work with clients that challenge our ability to find things to praise, and offer an endless series of invitations to focus on what’s not working. So, keep the faith data-driven knowledge!
Take home
Therapists, whomever you work with, praising clients for what they do well, especially when you explain what you’re praising them for, will encourage them to stay in treatment and learn skills quicker.
This is important because some esoteric schools of therapy come up with arguments against giving praise. I respectfully continue my theme of encouraging you to give more weight to therapy instruction that has convergent validity across “brands”.
Supervisors, supervisees and any therapists just trying to get better at what you do: video-record your sessions and watch them. You may only need to watch 10 minutes to get a read on how you’re doing.
Try this (I dare you): record a session this week and notice how many times you praised a client for what they did well
Go to https://www.tandfonline.com/doi/abs/10.1080/15374416.2015.1063428?journalCode=hcap20for the original article.
References
Barnett, .L., Niec, L.N., Peer, S.O., Jent, J.F., Weinstein, A., Gisbert, P., & Simpson, G. (2017) Successful Therapist–Parent Coaching: How In Vivo Feedback Relates to Parent Engagement in Parent–Child Interaction Therapy. Journal of Clinical Child & Adolescent Psychology, 46:6, 895-902, DOI: 10.1080/15374416.2015.1063428