Emotion-Focused Parenting Interventions Improve Outcomes After Adolescents Mental Health Treatment Programs

How To Connect to Your Teen After Treatment

When your teen receives a diagnosis for a mental health, behavioral, or addiction disorder, your life changes. The first thing you do is find them the best evidence-based care available. Depending on their diagnosis and the severity of the disorder, your teen may receive a referral for:

• Outpatient/Virtual Outpatient Treatment. This is an entry level of care which typically occurs once or twice a week in an office setting.
• Intensive Outpatient Treatment (IOP). This is one level up from outpatient treatment, which typically occurs 3-5 days a week for 2-4 hours per day.
• Partial Hospitalization Treatment (PHP). This is one level up from intensive outpatient treatment. PHP treatment is more immersive, and typically occurs 5 days a week for 4-6 hours per day.
• Residential Treatment (RTC). Aside from psychiatric hospitalization, this is the most immersive level of care common in adolescent mental health treatment. During RTC programs, teens live at the treatment center and receive 24/7 support and care.

Outpatient treatment is typically office-based, whereas treatment at the IOP, PHP, or RTC levels of care most often occur at mental health hospitals or treatment centers for teens, adolescent mental hospitals or treatment centers, or specialized mental hospitals for minors.

The whole process of getting your teen into treatment can be challenging. From finding the right treatment center, to deciding which level of care they need, to actually committing to a program, every step of the way is a mix of big-picture life decisions for you and your teen. It’s colored by emotions like fear and anxiety, but also by emotions like optimism and hope. You may fear the unknowns but feel positive about the prospect of helping your teen heal and grow.

This article reviews the latest research on how you can best support your teen after inpatient residential treatment.

What is an Emotion-Focused Parenting Intervention?

In a meta-analysis published recently in Current Opinion in Psychiatry called Emotion-Focused Parenting Interventions for Prevention and Treatment of Child and Adolescent Mental Health Problems: A Review of Recent Literature, researchers reviewed fifty studies on emotion-focused parenting programs. They identified the primary types of interventions currently available, the purpose of the interventions, and the four primary family and relationship domains the interventions address.

We’ll start with the purpose of an emotion-focused parenting intervention. These programs are designed to:

• Identify the emotions and emotional nuances present in the family and in family relationships
• Identify the ways parents and teens communicate about these emotions
• Help parents understand their teen’s emotional experiences
• Help parents understand their own emotional experiences related to their teen
• Teach parents to support their teens as they work through intense emotional experiences
• Teach parents skills to promote, rather than impede, healthy emotional functioning in the family unit

Decades of research indicates that when you, as a parent, participate in your teen’s treatment process, you can help your teen successfully reintegrate into daily life when they return home after treatment. This recent research shows that when you understand how to offer emotional support for your teens after they spend time in a residential mental health treatment program, their post-treatment outcomes improve. One effective way to learn to offer that support is through participation in an emotion-focused parenting program.

Types of Emotion-Focused Parenting Programs

In the meta-analysis we cite above, researchers identified and reviewed four effective types of emotion-focused parenting programs for teens who receive inpatient treatment at mental hospitals for teens or specialized mental hospitals for minors.

Here are the five types of programs they found:

1. Emotional coaching and emotional communication programs
2. Emotion-focused family therapy programs
3. Attachment-focused parenting interventions
4. Mindfulness programs
5. Behavioral programs that include and emotional focus

All of the effective interventions they reviewed targeted four primary domains:

1. Exploration of original and early attachment and relationship experiences with strong emotional components
2. Parental awareness of emotions, emotional interactions, and emotion regulation
3. Adapting, shifting, and improving parental responses to their children’s or teen’s emotions, with a focus on how to best communicate with a teen when intense or difficult emotions appear
4. Improving parents’ skills and giving parents tools to help teens regulate emotion and emotion-driven behavior

As you can see, emotion-focused parenting interventions are more about your than they are about your teenager. Although your teenager is the one returning home from an inpatient or residential mental health treatment program – and they’re the one with the diagnosis – what these programs teach is how you can navigate all things emotion-related.

And for teens, almost all things are emotion-related – whether they admit it or not.

What’s unique about these programs is that they take a different approach than most programs designed to support teens with a mental health or behavioral diagnosis. Whereas many programs focus on teaching and implementing behavioral/behavioral management strategies, these programs fine-tune their attention to the emotions behind the behaviors. The authors of the meta-analysis found that an emotion-focused approach is particularly beneficial for teens who experience significant emotional dysregulation.

How Emotion-Focused Parenting Interventions and Emotion-Focused Family Therapy Works

First, it’s important to understand that emotional dysregulation means:

• An absence of awareness, inability to accept, or difficulty understanding emotions
• The absence of skills, tools, or strategies for managing difficult emotions
• A low tolerance for difficult emotions while problem-solving or attempting to achieve specific personal goals
• An inability to problem-solve or achieve specific personal goals while experiencing difficult emotions

Let’s quickly identify the types of mental health disorders that may involve significant emotional dysregulation. This will help you understand whether adopting an emotion-focused parenting approach can help your teen when they return from inpatient treatment in an adolescent mental health hospital. The disorders that most commonly include emotional dysregulation are:

• Depressive disorders
• Anxiety disorders
• Bipolar disorder
• Borderline personality disorder
• Disruptive mood dysregulation disorder
• Oppositional defiant disorder
• Behavioral disorder
• Attention-deficit hyperactivity disorder

Now that we’re on the same page with what emotional dysregulation is and which disorders are characterized by significant emotional dysregulation, let’s review how a therapist might work with you and your teen in an emotion-focused parenting intervention or during emotion-focused family therapy.

A chapter in a peer-reviewed book on family therapy called Emotionally Focused Family Therapy: Rebuilding Family Bonds describes a three-stage process in family therapy that’s analogous to the process in a parenting intervention.

Here’s how the process works:

Stage One: Identifying and De-Escalating Family Distress

1. A therapist will get to know you, or you and your teen, and assess your current family dynamic.
2. They identify any counterproductive patterns of interaction related to your teen’s emotional attachment need.
3. They identify the underlying emotions related to the counterproductive patterns of interaction.
4. In collaboration with you, or you and your teen, they help reframe the communication problems in terms of emotions and emotion-based interactions

This stage is about guiding you and your teen away from the content of your interactions and toward the emotions underlying those interactions.

Stage Two: Restructuring Interactions

1. The therapist helps you and your teen identify your teen’s unmet emotional attachment needs.
2. They help you and your teen accept their new emotional experiences and attachment/emotion-related needs.
3. The therapist helps you and your teen restructure your interactions, with a focus on meeting shared emotion/attachment needs and helping you, as a parent, offer supportive caregiving responses to your teens emotional needs.

This stage is about diving deep to broaden your understanding of your teen’s primary emotions and unmet attachment needs. The goal is to rebuild the bond between you and your teen so you both feel safe, secure, and connected.

Stage Three: Consolidation

1. The therapist helps you and your teen create and implement new approaches to old challenges, based on your new knowledge and awareness of the emotional component of your interactions, and grounded in a new position of safety and security.
2. The therapist helps you solidify – consolidation means to make solid ­– and strengthen your new patterns of interaction.

This stage is about integrating your new knowledge into daily family life. The therapist helps you and your teen understand that these approaches are not one-offs, only related to the specific issues you cover during therapy. Rather, what you learn is a template you can use to apply to any and all future emotion-based interactions between you and your teen. Remember: for a teen, almost everything is about emotion, whether they admit it or not. At this stage, you and your teen may discover a new level of interaction, based on security, openness, and emotional responsiveness.

How This Approach Helps Families Heal

What we outline above is the theory behind emotion-focused parenting, the goals of emotion-focused parenting, and the process of emotion-focused family therapy, which is analogous to the process of an emotion-focused parenting intervention.

The goals are clear. The programs seek to help families understand one another on an emotional level. They help facilitate communication and offer one another support when they need it most. Of course, what we’re talking about here is how parents can best support their teenagers as they make the transition – which can be difficult – from inpatient treatment to daily life back at home.

A paper called Tuning In to Kids: An Emotion-Focused Parenting Program—Initial Findings From a Community Trial documents the experience of families who’ve been through this process. It includes reports from parents about how participation in the program improved their parenting, their relationship with their kids, and their kids’ behavior and ability to manage the symptoms of the disorder for which they entered treatment.

After taking part in the parenting program, the parents in this study reported overwhelmingly positive results.

The Impact of an Emotion-Focused Parenting Program

Immediately after the program, parents said:

• They had an increased ability to respond to their children’s emotional states
•  They had an increased ability to respond to their children’s emotions in supportive ways
• For the first time, they were able to empathize and connect with their children on emotional issues and anything emotion-related
• For the first time, they realized their child’s difficulties – with regards to mental health and behavior – were most often the result of their inability to express, understand, and resolve their emotional states
• That meeting their child on an emotional level, before the emotion escalated in intensity, enabled them to help their children more effectively than waiting to engage after their child’s emotion overpowered their ability to cope
• Meeting their child on an emotional level helped them help their children develop and implement the emotional regulation skills necessary to prevent emotions from driving behavior to disruptive levels

While this study focused on school-age kids, the lessons the parents learned in the bullet points above are directly transferrable to you and your teen. When your teen leaves treatment, it’s important to understand they’re in a new place. They have new awareness, new skills, and a new point of view. When you learn to meet them on that level – with the language of therapy and a sensitivity to the emotional component of your interactions – you can help them implement everything they learn in treatment and make emotionally aware communication a default part of your family dynamic.

You and Your Teen Can Make It Work

One outcome of the study above was that when parents adopted an emotion-focused approach, their children’s behavior improved. In many cases, it no longer met a clinical threshold for dysfunction. The same can be true for a teen returning from inpatient treatment.

When you take an emotion-focused approach to interacting with your teen, you help them manage the symptoms of their disorder.

Your emotional awareness and compassionate support gives them the confidence, sense of safety, and feeling of belonging that allows them to process their emotions and keep any mental health symptoms at a non-disruptive level. This, in turn, allows them to fully participate in life at home, at school, and with their peers.

But let’s be clear: tuning in to emotions doesn’t mean you become a pushover. They still have to clean their room and do their chores. You’re still the parent.

What we mean is that when your teen returns from inpatient treatment, one of the best ways to support them on their journey – and rebuild balance in your family – is to focus on what’s inside. Focus on their emotions. Be acutely aware of their internal life. Surround them with empathy, compassion, and understanding, and you’ll increase their chances of achieving long-term resiliency and emotional well-being.