Becoming Therapeutic Agents: A Grounded Theory of Mothers’ Process when Implementing Cognitive Behavioural Therapy at home with an Anxious Child

Abstract

The premise of parent-centered programs for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behavioural therapy (CBT) in the home. The existing operationalization of parent involvement however, does not address the systemic, parent, or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one’s child in one’s home. A grounded theory goes beyond the description of a process, offering an explanatory theory that brings taken-for-granted meanings and processes to the surface. The theory that emerged from the analysis suggests that CBT implementation by mothers of anxious children is characterized by the evolution of mothers’ perception of their child from being ‘held back’ to being ‘mostly independent with ongoing needs’ and mothers’ perception of their role from being a ‘comforter/protector’ to being a ‘supporter/advocate’. This process allows a strategic shift in parenting strategies from reacting with emotion to responding pragmatically to the child. Changes occur as mothers recognize the crisis, make links between the treatment rationale, child’s symptoms, and their own parenting strategies, integrate tenets of CBT for anxiety, and eventually focus on sustaining therapeutic gains through natural life transitions. Mothers whose anxious child made threats of suicide and/or engaged in non-suicidal self-injury experience distinct phases and challenges. This theory widens our understanding of mothers’ role, therapeutic engagement, process, and decision-making. It allows clinicians to provide better support, anticipate difficulties, and to respond accordingly. The theory generates also new hypotheses regarding parent involvement in the treatment of pediatric anxiety disorders, and proposes novel research avenues focused on mothers’ cognitions and parenting strategies.