Promoting Parent Engagement in Child Psychotherapy: Therapists' Perspectives on Parent, Therapist and System-Level Barriers and Facilitators

Abstract Parental engagement in their child's therapy is increasingly recognized as a crucial component for successful treatment outcomes. However, various barriers at the levels of parents, therapists, and the broader system impede active participation and necessitate targeted therapeutic strategies. This study explores therapists' insights into the challenges of parental engagement in child therapy and the strategies employed to enhance it. An exploratory grounded theory approach was utilized, involving in-depth, semi-structured interviews with 15 therapists to gather data on their experiences in engaging parents. Data analysis was conducted using constant comparison, in vivo coding, and conceptual coding techniques. Our Findings indicate that parental engagement is influenced by barriers operating across three interconnected levels. At the parental level, failure to recognize their role in their child’s difficulties, fear of being judged, and emotional burden were identified as significant barriers. At the therapist level, feelings of incompetence and negative emotions about parental disengagement often reduce therapists’ efforts to involve parents in their child’s treatment. At the systemic level, maintaining a balance between structured settings for parental meetings and necessary flexibility was identified as a key factor affecting engagement. The therapeutic alliance with parents emerged as a central element, both hindered by these barriers and capable of mitigating them to promote engagement. In conclusion, it is essential that training programs for child therapists include modules on recognizing barriers to parental engagement, developing skills to strengthen the therapeutic alliance, and designing a therapeutic setting that facilitates parents’ engagement.