Parent management training : treatment for oppositional, aggressive, and antisocial behavior in children and adolescents PDF
Preview Parent management training : treatment for oppositional, aggressive, and antisocial behavior in children and adolescents
Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents Alan E. Kazdin, Ph.D. OXFORD UNIVERSITY PRESS Parent Management Training This page intentionally left blank Parent Management Training Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents Alan E. Kazdin, Ph.D. 1 3 Oxford University Press,Inc.,publishes works that further Oxford University’s objective ofexcellence in research,scholarship,and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © by Oxford University Press,Inc. Published by Oxford University Press,Inc. Madison Avenue,New York,New York www.oup.com Oxford is a registered trademark ofOxford University Press All rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system,or transmitted,in any form or by any means, electronic,mechanical,photocopying,recording,or otherwise, without the prior permission ofOxford University Press. Library ofCongress Cataloging-in-Publication Data Kazdin,Alan E. Parent management training : treatment for oppositional,aggressive,and antisocial behavior in children and adolescents / Alan E.Kazdin. p. cm. Includes bibliographical references and indexes. ISBN----- ISBN--- .Child psychotherapy—Parent participation. .Behavior disorders in children— Treatment. .Behavior disorders in teenagers—Treatment. .Child psychopathology. .Adolescent psychpathology. .Parenting—Study and teaching. .Child rearing— Study and teaching. .Parent and child—Psychological aspects. I.Title. RJ.PK .(cid:1)—dc Printed in the United States ofAmerica on acid-free paper This book is dedicated to parents, parenting, and parent training. Being a parent has been the most enjoyable and rewarding experience for me. Parenting, as is the case with most worthwhile activities, is enormously challenging to say the least. My situation has been eased by my children Nicole and Michelle, who trained their parents well and with the use of few aversive consequences. This page intentionally left blank Preface Do professionals really need another book on psychotherapy for children and adolescents? The genre is already vast. Invariably “new and improved”tech- niques continue to appear, which is why we already have over forms of therapy in use for children.It is as ifinventing another therapy or a slight nu- ance ofan existing treatment is one professional path to academic immortal- ity.The impetus for this book is quite different.Parent management training (PMT) has rather special status as a form ofpsychotherapy or psychosocial in- tervention for clinical problems.In the context ofchild and adolescent psycho- therapy,there is probably no other treatment with such strong evidence in its behalf.That alone would distinguish the treatment and lobby for its presenta- tion.However,the importance of the focus is heightened by the ironic situa- tion that PMT is rarely taught,discussed,or even mentioned in clinical training ofchild psychiatrists,clinical psychologists,school counselors,social workers, and psychiatric nurses.Thus,the people who provide direct services to chil- dren and adolescents rarely have opportunities to learn about this treatment, leaving aside formal supervised training that would develop the ability to ad- minister the treatment in practice.Impetus for this book derives from the need to provide information about the treatment,its underpinnings,and concrete application in therapy. Scholarly reviews of the research on PMT are widely available in journal articles and book chapters.In addition,treatment manuals and some self-help books for parents are available describing features ofthe intervention.There is a void between these two types ofpublications and in an effort toward their in- tegration. This book is designed to redress this void by covering theory, re- search,and practice ofPMT in a way that is clinically friendly and usable. The book is presented in two integrated sections. The first section pro- vides the background,principles,and concepts underlying PMT.This section highlights the key principles on which PMT is based and the techniques that derive from them.In addition,research on PMT is highlighted to support the claim that this is a well-studied intervention,to convey what we understand about how PMT works,and to identify what can be done to enhance the effects oftreatment.No effort is made to cover all ofthe vast research that is available. Indeed,research on PMT continues to emerge and any updated report could be easily outdated ifone attempted to cover nuances ofthis or that finding.Yet there is a fundamental body ofresearch that is important to cover.Gaps in re- search and limitations ofour understanding will also be mentioned to ensure that any hint that PMT is a panacea for outpatient treatment is explicitly coun- tered.The first section ofthe book also discusses a range ofissues that emerge in using PMT clinically.Variations of treatment, the content, sequence, and style of the sessions,ancillary procedures to add to PMT,obstacles that may emerge in treatment,and what to do if treatment is not working well are de- tailed.The first section ofthe book is not heavily burdened with concepts and terms.Even so,a glossary at the end ofthis section is provided to place all key concepts on one section. The second section ofthis book provides a treatment manual ofPMT,as applied in outpatient treatment for children and adolescents referred for op- positional,aggressive,and antisocial behavior.There are multiple variations of PMT.The variations differ in part as a function ofthe age ofthe children who are treated and the severity and scope ofimpairment they show.The common features pertain to the content and foci of the sessions and the key interven- tions that carry the burden of producing therapeutic change. This book in- cludes a treatment manual that has been used with children and adolescents (–years ofage) for a period spanning years.The manual has been revised based on findings ofmany investigators,our own research,and even more so from clinical application.The manual is not a substitute for supervised train- ing.Yet,the manual conveys a detailed description of what is done to and by whom,what is said by the therapist in the sessions,and materials (e.g.,hand- outs,aides for the parent) at each stage oftreatment. The first and second parts ofthe book are connected by more than a com- mon binding from the printer.Rather,the initial part focuses not only on prin- ciples but issues and obstacles that emerge clinically and what can be done about them.An effort is made to move from the general (background,prin- ciples,theory) to the specific (e.g.,techniques,dialogue of the therapist,par- ent,and child and materials used in treatment).Also,the first and second parts are designed to address clinically important issues.For example,PMT is very effective but may be weak or ineffective for any given clinical case.What can be done? Actually a great deal.PMT encompasses an extensive array ofquite spe- cific options of what to do to improve ailing programs.Also,PMT may work well ifthe parent carries out the procedures,but parent adherence can be a key problem.What can be done ifthe parents cannot or do not do the program at viii Preface home? Here too,there is much to say and do to develop adherence in the par- ent.These and other questions are addressed;they are clinically critical ques- tions but they are also informed by the principles and findings ofPMT as well as by concrete strategies for use within the sessions.In short,the goal of this book is to provide a package that encompasses theory,research,and applica- tion in the confines ofa readable book. Research findings on PMT are excellent for establishing the effects oftreat- ment and for answering facets about who responds.The book supplements the knowledge base with practical details about how to apply the treatment clini- cally.The details have benefited from the experience ofseveral therapists who have applied this manual to families seen in short-term inpatient treatment and outpatient therapy.I have been very fortunate to have the opportunity to work with several therapists and clinic staffwho have been directly involved in pro- viding the treatment detailed in this book. At the University of Pittsburgh School of Medicine’s Department of Psychiatry,a variation of the treatment described in this book was developed initially as treatment for inpatient chil- dren (ages –) who were to be discharged to their parents.The treatment was also used for cases seen only on an outpatient basis.At Yale University’s De- partment ofPsychology and Child Study Center,the treatment has been pro- vided in an outpatient service (Child Conduct Clinic) for children and adoles- cents (ages –).At Yale,staffofthe Child Conduct Clinic have included:Elif Attaroglu,Wayne Ayers,Justin Barsanti,Susan Breton,Elizabeth Brown,Susan Bullerdick, Erin Carrubba, Mary Cavaleri, Michael Crowley, Lisa Holland, Bernadette Lecza, Jennifer Mazurick, Molly McDonald, Michelle Ragozzine, Gloria Wassell,and Moira Whitley.Several graduate students have also worked at the clinic and contributed greatly including:Andres De Los Reyes,Jerusha Detweiler,Julie Feldman,Lori Hilt,Sara Lederman,Paul Marciano,Matthew Nock,and Francheska Perepletchikova.The extensive experience ofthese thera- pists and our daily interactions over cases has shaped the treatment as well as the research we were able to complete in applying the treatment clinically. I am very pleased to acknowledge support that made this work possible. Support from the National Institute ofMental Health (Research Scientist and Senior Scientist Awards,and a MERIT Award),The William T.Grant Founda- tion,and Leon Lowenstein Foundation were pivotal to the work. Preface ix
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