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Journal of Child Psychology and Psychiatry **:* (2021), pp **–** doi:10.1111/jcpp.13378

PRACTITIONER REVIEW

Practitioner Review: Parenting interventions for child

conduct problems: reconceptualising resistance to
change
David J. Hawes, and Mark R. Dadds
School of Psychology, The University of Sydney, Sydney, NSW, Australia

Parenting interventions based on social learning theory have received extensive empirical support in the treatment of
child conduct problems; yet, they fail to produce lasting gains in as many as a third of cases. Perspectives on these
poor outcomes have been informed by numerous lines of research, and practitioner recommendations for improving
such outcomes have often emphasized processes related to clinical engagement. In this Practitioner Review, we
examine recent theory and evidence pertaining to these processes, including emerging research into the therapeutic
relationship across face-to-face and eHealth treatment modalities, and the clinical engagement of both mothers and
fathers. The concept of resistance to change is examined in light of these developments, and it is argued that the
process of overcoming such resistance can be characterized as one of reflective practice. A novel process model based
on this perspective is presented, comprising practical clinical strategies that are designed to be initiated from the
earliest contacts with a family and build on one another across treatment. Keywords: Conduct problems;
externalizing problems; treatment; parenting interventions; engagement.

resistance (Dadds & Hawes, 2006; Scott & Dadds,

Introduction
2009). In this review, we address key developments
The most effective interventions for child conduct
from the past decade, including research into the
problems (CPs) are parenting interventions based on
therapeutic relationship across face-to-face and
social learning theory (Kaminski & Claussen, 2017).
eHealth treatment modalities, and the clinical
The packaging of these interventions into manual-
engagement of both mothers and fathers. We con-
ized programs has been instrumental to the growth
ceptualize resistance to change within the broader
in dissemination of evidence-based treatment for
context of such engagement and present a novel
CPs, which in recent years has extended to a global
process model for overcoming such resistance
scale. At the same time, poor outcomes are typically
through reflective practice.
seen in a quarter to a third of children with CPs
following such treatment (e.g. Drugli, Larsson, Fos-
sum, & Mørch, 2010), and the challenges associated Innovations in treatment design
with the delivery of these interventions have received
Evidence regarding the risk-mechanisms underlying
growing recognition (Weisenmuller & Hilton, 2020).
CPs has grown rapidly in recent years, informing
Perspectives on these poor outcomes have been
research into adaptations of parenting interventions
informed by research investigating predictors and
for subgroups at particular risk for poor outcomes
moderators of treatment response at the levels of the
(Fairchild et al., 2019). Children with CPs and high
child (e.g. callous and unemotional traits), parent
levels of callous and unemotional (CU) traits (e.g.
(e.g. psychopathology), family (e.g. marital conflict),
lack of guilt and empathy) are a key example (Hawes,
and broader ecological context (e.g. social adversity)
Price, & Dadds, 2014). We have found that the
(Gardner et al., 2019; Leijten et al., 2019, 2020).
treatment outcomes of such children can be
Given the nature of this treatment, a key focus has
enhanced by incorporating an adjunctive component
also been placed on clinical processes between
targeting children’s emotion processing (e.g. recog-
parents and therapists that have been described in
nition and understanding of emotional cues) into
terms of resistance to change (Patterson & Cham-
such treatment (Dadds, Cauchi, Wimalaweera,
berlain, 1994).
Hawes, & Brennan, 2012). Findings for similar
Theory and evidence regarding the therapeutic
enhancements of other social-learning-based inter-
relationship and broader delivery of such treatment
ventions for this purpose have also been promising
has evolved considerably in recent years, and it is
(e.g. Kimonis et al., 2018).
timely to update practitioner recommendations con-
Inherent in such research, however, has been the
cerning clinical process strategies regarding such
challenge of producing gains that extend beyond the
already strong effects typically produced by exist-
Conflict of interest statement: No conflicts declared.
ing parenting interventions, particularly in early

© 2021 Association for Child and Adolescent Mental Health

Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA
2 David J. Hawes and Mark R. Dadds
childhood. For example, Dadds, English, Wimala-
weera, Schollar-Root, and Hawes (2019) found that
parent training with an adjunctive component tar-
geting emotional engagement (e.g. shared eye-con-
tact) in the parent–child relationship reduced both
CPs and CU traits in the magnitude of large effect
sizes, but so did our standard parenting intervention
alone (Dadds & Hawes, 2006), and child outcomes
did not differ between these conditions. In contrast
to the recent evolution of developmental models of
CPs, the common elements shared by evidence-
based parenting interventions have changed rela-
tively little over time, and efforts to improve the
treatment of children with CPs have focused
largely on overcoming barriers to delivery and
implementation.
Treatment delivery in the digital age
A range of factors are known to impact on access to,
and participation in, parenting interventions for
CPs. These include the lack of clinical infrastructure
commonly found in underserviced and remote com-
munities, along with factors that may impact on
engagement with traditional services (e.g. parent
mental health, childcare demands) (Chacko et al.,
2016). Online (i.e. telehealth or eHealth) parenting
interventions have been a key focus of recommen-
dations for overcoming such barriers (Weisenmuller
& Hilton, 2020). The most scalable eHealth inter-
ventions are self-directed (i.e. therapist-free), and
have been shown to produce moderate-to-large
sized reductions in CPs among treatment com-
pleters (Day & Sanders, 2018; Piotrowska et al.,
2019). While we have found that mothers and
fathers can be engaged in such an intervention at
comparable rates, attrition in self-directed interven-
tions is often high. Moreover, we found that parents
who discontinued had significantly more dysfunc-
tional parenting practices than completers, suggest-
ing that therapist contact may be particularly
important for high-risk families (Dadds, Sicouri,
et al., 2019).
Research has also begun to investigate the poten-
tial impact of online delivery on the therapeutic
relationship. In recent multisite trials, we found
therapist-assisted eHealth to be just as effective as
face-to-face treatment in reducing CPs, and saw
large and consistent treatment effects across fami-
lies from both urban and remote/rural regions
(Dadds, Thai, et al., 2019). Importantly, we further
found that parents’ perceptions of the therapeutic
alliance were stable across these formats and
regions. Findings suggest, however, that while par-
ents’ perceptions of the therapeutic alliance and
their own in-session engagement do not differ across
these formats, clinicians may feel more empowered
and efficacious delivering face-to-face treatment
(Kirkman, Hawes, & Dadds, 2016).
Conceptualizing resistance to change in
parenting interventions
Parents of children with CPs often feel in desperate
need of help by the time they meet with a therapist,
but this in no way guarantees that they will act on
the recommendations they receive. To define our use
of the term ‘resistance’ in this context, we borrow
from Miller and Rollnick (2012), who deconstructed
the concept of resistance into ‘sustain talk’ and
‘discord’. Sustain talk refers to client motivations
and verbalizations favouring the status quo. This
can be seen in the expressions of ‘I can’t’ (e.g.
defensiveness, hopelessness, blame, and side-track-
ing); ‘I won’t’ (e.g. disagreements, complaints, chal-
lenging to the therapist’s competence); and
noncompliance with homework, previously used to
operationalize resistance in observational studies of
parent training (Chamberlain, Patterson, Reid, Kava-
nagh, & Forgatch, 1984). Sustain talk is not inher-
ently oppositional and can be seen simply as one
side of the ambivalence experienced by individuals
as they progress through the stages that reflect
growing readiness to change (Prochaska & DiCle-
mente, 1982). Discord refers to a state of disagree-
ment between therapist and client regarding the
goals or activities of treatment and is therefore based
distinctly in the therapeutic relationship (Miller &
Rollnick, 2012). This dual definition reflects a focus
on natural parts of the change process and a
rejection of the client-blame at times associated with
historical use of the term.
These components of resistance should not be
conflated with the various ecological factors that may
interfere with engagement in parenting interven-
tions. Socioeconomic disadvantage has been associ-
ated with increased rates of parent drop-out (Chacko
et al., 2016), and parent mental health, family
violence, stigma, and cultural factors, may likewise
serve as barriers to engagement (Weisenmuller &
Hilton, 2020). Moreover, families may rightly reject
treatment that is poor quality or does not meet their
needs. Such factors, however, have not only been
associated with poor uptake and drop-out, but also
with resistance during treatment. For example,
socioeconomic disadvantage, parent psychopathol-
ogy (e.g. depression, parental antisocial behavior),
and dysfunctional parenting practices, have all been
found to predict the persistence of sustain talk by
parents of children with CPs (Patterson & Chamber-
lain, 1994; Stoolmiller, Duncan, Bank, & Patterson,
1993).
Central to Patterson and Chamberlain’s (1994)
model of resistance to change in such treatment was
the idea of resistance as parental avoidance. This
account emphasized the negative emotions (e.g.
anger, guilt, and shame) that parents often bring
with them to treatment, stemming from a metaphor-
ical ‘history of 10,000 defeats’ in the discipline
arena. It was predicted that these emotions underlie
© 2021 Association for Child and Adolescent Mental Health

parents’ avoidance of future discipline encounters
despite the new approaches to discipline presented
in treatment. When parents are flooded by these
emotions, their capacity to read and respond to child
cues is often compromised (Mence et al., 2014). The
attributions that accompany these emotions often
form a family story about why the child is antisocial
and does not respond to discipline, and this is
expected to drive resistance to the extent that it
diverges from the therapist’s point of view. Early
observational data showed that parental resistance
often operates to ‘turn off’ the therapist. Specifically,
it reduces caring and empathic responses, while
increasing therapists’ use of confrontation and dis-
like for clients, and data indicate that these coun-
tertherapeutic responses in turn feed back into that
resistance (Patterson & Chamberlain, 1994).
This conceptualization, therefore, considers resis-
tance not as a characteristic of some parents, but a
process that may be driven by parents and thera-
pists. Building on this, we propose an updated
account in which resistance is conceptualized within
the broader process of clinical engagement, as illus-
trated in Figure 1 and outlined in the following
sections. While parental avoidance remains central
to this account, it is predicted that the proximal
drivers of this avoidance include parent factors
comprising negative emotions, attributions, knowl-
edge and skills, self-efficacy, and confidence, as well
as therapist emotion and responses that are con-
frontational or likewise avoidant.
An expanded account of engagement and
resistance
Engagement in child mental health services has been
conceptualized as a multidimensional construct
comprising multiple stages, levels, and domains,
each of which may be associated with distinct
barriers and facilitators (Becker et al., 2015). While
considerable research has examined attendance (e.g.
drop-out) in parenting interventions, however, the
Figure 1 Resistance in the context of parent-therapist dynamics
© 2021 Association for Child and Adolescent Mental Health
Parenting interventions for conduct problems 3
active participation or adherence of parents in
treatment (e.g. within-session engagement, home-
work completion), has been relatively neglected
(Haine-Schlagel & Walsh, 2015; Nock & Ferriter,
2005), as has the role of family systems in this
engagement. Our own work reflects a process model
of parental engagement that encompasses the four
key stages of (1) initiation of, or recruitment into,
treatment (Connect); (2) retention throughout treat-
ment (Attend); (3) active involvement in treatment,
including paying attention in sessions, being recep-
tive and open to new ways of interacting with
children, asking questioning and contributing to in-
session discussions and activities, and completion of
scheduled homework activities (Participate); and (4)
implementation of newly acquired skills and strate-
gies in day-to-day life (Enact) (CAPE; (Piotrowska
et al., 2017). Notwithstanding the importance of
connecting with families in need and encouraging
parental attendance, it is parents’ active participa-
tion that is most critical to producing the enduring
change in parenting processes (enactment) upon
which successful treatment relies. This expanded
account of engagement provides a basis for concep-
tualizing the drivers of sustain talk and discord
between parents and therapists, as follows.
From participation to enactment
Three sets of parenting processes have been theo-
rized to function as mechanisms by which participa-
tion leads to enactment (Piotrowska et al., 2017). The
first is parenting knowledge and skills. Included here
is knowledge about child behavior and effective, age-
appropriate, parenting practices, which is expected
to increase throughout treatment, as shown in our
recent research into the measurement of such
knowledge during face-to-face and eHealth treat-
ment (Kirkman, Dadds, & Hawes, 2018). Second is
parent self-efficacy and confidence (King, Currie, &
Petersen, 2014), which has been found to mediate
the effects of such interventions on parenting
4 David J. Hawes and Mark R. Dadds
practices (Seabra-Santos et al., 2016). Third, par-
ental attributions about child behavior represent a
critical aspect of the parent–child relationship and
may be subject to a range of biases (e.g. hostile
intent; emphasizing causes that are stable and
internal to the child) that interfere with parenting
and treatment (Sawrikar & Dadds, 2018). In line
with the prediction that attributional change is
implicated in the broader change processes of treat-
ment, we found that improvements in mothers’
attributions explained unique variance in the out-
comes of children with CPs 3 months following
treatment (Sawrikar, Hawes, Moul, & Dadds, 2019).
As shown in Figure 1, we predict that poor
improvement in these mechanisms may stem from
parents’ avoidance of discipline confrontations,
while at the same time feeding back into ongoing
cycles of avoidance, sustain talk, and discord. From
this perspective, clinical methods that promote par-
enting skills and self-efficacy may also enhance the
therapeutic relationship and its capacity to support
change. Such methods typically emphasis active
learning, with well-known examples including role
play and in-vivo coaching. Lesser known methods
include video feedback, whereby parents of young
children are shown examples of themselves applying
new skills effectively with their child, along with
ineffective examples to pinpoint opportunities for
skill development (Fukkink, 2008). While not feasi-
ble in all settings, video feedback has been used
successfully in various parenting interventions for
CPs (e.g. Dadds et al., 2019; Smith, Dishion, Moore,
Shaw, & Wilson, 2013). The specific parenting chal-
lenges implicated in each of these mechanisms may
also differ based on the age of the child. For example,
limit-setting in the preschool years differs markedly
to that in later childhood and adolescence, when
children play a more active role in negotiating limits
and consequences, and in implementing compo-
nents of treatment (e.g. family-based communication
and problem-solving skills). Accordingly, specific
developmental periods may place distinct demands
on parent knowledge, skills, and self-efficacy, and
have important implications for the kinds of issues
that evoke parent emotions and attributions in the
context of treatment.
A systemic perspective on parental engagement and
resistance
The clinical engagement of multiple parents or
caregivers may at times rely on distinct forms of
participation, as differentiated in the CAPE model
(Piotrowska et al., 2017). Direct participation
involves active commitment and direct contact with
a therapist/service; whereas, indirect participation
involves acquisition of information from other
sources. For some families, the combination of direct
and indirect participation may enable them to over-
come barriers to treatment. For example, one parent
may attend sessions in person and pass on strate-
gies to a partner prevented from attending due to
work demands.
Family context factors are predicted to increase or
decrease the likelihood of parents’ active participa-
tion in treatment and its translation into enduring
change (Piotrowska et al., 2017). According to Min-
uchin’s (1974) model, the family system is charac-
terized as consisting of overlapping but independent
subsystems that are organized hierarchically. In a
healthy family structure, parents form an executive
subsystem that holds the highest level of power and
is able to solve family problems through teamwork
and leadership. We predict that the quality of this
executive subsystem, or ‘parenting team’, functions
as a key contextual moderator of this kind. Other
potential moderators include household chaos (e.g.
lack of routine and order; Coldwell, Pike, & Dunn,
2006). Cultural factors and beliefs about parenting
roles (e.g. devaluing the role of fathers in caregiving;
Cabrera, Volling, & Barr, 2018), may also be impor-
tant here, and the involvement of fathers in parenting
has been a focus of research on cultural adaptations
of parenting interventions (see Mejia et al., 2017).
Parents’ attempts to implement new strategies
with their children are more likely to fail when a
parenting team is dysfunctional (e.g. inconsistent
and unsupportive). Aversive experiences of discipline
may therefore continue and further contribute to
ongoing avoidance of discipline confrontations. Par-
ents seeking help for CPs may be reluctant to discuss
their own relationship, and such systemic problems
may be associated with other highly sensitive and
emotional issues (e.g. distressing family of origin
experiences; cultural beliefs about parenting or
mental health). It is understandable that therapists
often avoid addressing sensitive systemic issues with
parents for these reasons, and we predict that such
avoidance contributes to resistance by limiting
opportunities to work openly and collaboratively
with parents to facilitate participation and enactment
at the family level.
Enhancing engagement of mothers & fathers
While literature on parenting interventions has
focused almost exclusively on mothers, emerging
evidence related to fathers has been highly informa-
tive with regard to parental engagement in recent
years (Panter-Brick et al., 2014; Tully, Hawes &
Dadds, in press). Barriers to engagement identified
in research with fathers include treatment costs and
occupational demands on time and availability
(Frank, Keown, Dittman, & Sanders, 2014; Tully
et al., 2018; Tully, Piotrowska, Collins, et al., 2017).
Additionally, research comparing mothers and
fathers of children with CPs has found that mothers
rated their readiness to change at higher levels than
fathers (Niec et al., 2015). Furthermore, parents’
beliefs regarding the credibility of a therapist and
© 2021 Association for Child and Adolescent Mental Health

expectancies about treatment have been shown to
predict adherence in parenting interventions (Nock,
Ferriter, & Holmberg, 2007), and may be of partic-
ular importance to father engagement. A treatment’s
evidence-base and a therapist’s level of training were
found to be among the most important factors
guiding Australian fathers’ decision-making regard-
ing treatment participation, and far more than
preferences for therapist gender (Tully et al., 2017).
Accordingly, information regarding therapist and
treatment credibility may be beneficial to emphasize
early in the engagement process.
In a survey of Australian child mental health
practitioners, we found that while the majority
viewed father participation as important, one third
reported low confidence in working with fathers
(Tully et al., 2018). We have also found, however,
that such practitioner confidence and competencies
can be strengthened through training in process
strategies based on the systemic perspective out-
lined (Burn et al., 2019). Competencies concerning
the early stages of connection and attendance include
the ability to identify the caregivers that comprise a
child’s core parenting team and to invite them to
participate accordingly. Based on the gate-keeping
role that mothers often play, this may necessitate
strategies for engaging fathers via mothers (e.g.
empowering mothers to make decisions regarding
the involvement of fathers). Key also is the ability to
identify discrepancies in assessment data from
mothers and fathers that may hold important infor-
mation about divisions in the parenting team.
Other such competencies and strategies promote
ongoing participation and enactment, such as max-
imizing the indirect participation of parents who
cannot participate directly, and forming a therapeu-
tic alliance with fathers and mothers, respectively.
Some strategies may seem counterintuitive, such as
inviting a parent to openly express a worldview that
places blame on his/her partner, yet doing so may
enable a therapist to communicate the validation
and empathy needed for this purpose. The ability to
address in-session conflict between parents is also
essential (Burn et al., 2019).
Overcoming resistance to change: a reflective
practice model
While rarely articulated explicitly, strategies for over-
coming resistance have been instrumental to the
delivery of the parenting interventions we have inves-
tigated in recent years (Dadds et al., 2012; Dadds,
English, English, Wimalaweera, Schollar-Root, &
Hawes, 2019; Dadds, Thai, et al., 2019). Much like
parenting strategies that reverse the effects of CPs on
parents, these strategies are concerned largely
with pre-empting and reversing the effects of resis-
tance on therapists and the therapeutic relationship
(Figure 2). Therapists’ reflections on their own
responses to resistance are therefore paramount.
© 2021 Association for Child and Adolescent Mental Health
Parenting interventions for conduct problems 5
Expect a struggle for change
It is normal for parents’ sustain talk to increase
across the initial-to-middle phases of treatment for
CPs, before reducing in the closing phases. Interest-
ingly, the total absence of such increases has been
associated with poor outcomes, leading researchers
to propose that this struggle and the working-
through of it are themselves important (Stoolmiller
et al., 1993). Sustain talk that persists, however, has
been associated with particularly poor outcomes and
may be important to preempt with strategies built
into routine practice.
First and foremost are strategies to form a thera-
peutic team with parents. Therapeutic alliance is
understood to comprise multiple components,
including a ‘personal alliance’ based on the interper-
sonal relationship, which a therapist may promote by
conveying authenticity, warmth, acceptance, and
empathy. It also comprises a ‘task-related alliance’,
based on a shared agenda for the goals, methods, and
focus of treatment, which may be enhanced through
mutual agreement about goals and by setting up
appropriate expectations about treatment (Green,
2006). This aim may be supported by process
strategies that include scheduling parent-centered
assessment interviews in which sensitive issues (e.g.
feelings toward the child, interparental conflict, and
parent mental health) can be openly discussed in the
absence of the child. Additionally, it is often more
beneficial to validate a parent’s worldview than
challenge negative attributions during this early
assessment stage (see also Hawes & Dadds, 2013;
Scott & Dadds, 2009). This focus on issues beyond
the immediate child behavior problem is supported
by evidence that engagement rates can be increased
by providing parents with opportunities to discuss
such additional stressors, particularly in families
with high levels of adversity (Prinz & Miller, 1994).
Elsewhere in the literature, support for similarly
proactive engagement strategies has come from
research based on the Family Check-Up (Shaw
et al., 2019). Here, motivation for change is enhanced
through a feedback session in which parents discuss
their perspectives on assessment findings, along with
relevant contextual factors such as family structure
and socioeconomic/cultural factors. Attention is
drawn to areas for change, but an emphasis is placed
on family strengths and the acknowledgement of
practices that are working for the parent.
Recognize the signs of a struggle
Our capacity to respond effectively to dynamics that
undermine change relies in part on our capacity to
recognize them. This means attending not only to
sustain talk by parents, but to cues that arise from
the effects of such talk on the therapist. Based in the
therapist’s own behavior, cognition, and affect, these
cues are accessible primarily via self-reflection. In
6 David J. Hawes and Mark R. Dadds
Figure 2 A reflective practice model for overcoming resistance in parenting interventions
terms of affect, sustain talk may elicit negative
emotions and related ‘countertransference’ associ-
ated with feelings of dislike that erode the therapeu-
tic alliance. In terms of therapist behavior, sustain
talk may elicit increases in confrontational
responses (e.g. disapproval and frustration) and
decreases in active-learning activities (e.g. role plays
and modeling). Therapists may also observe them-
selves sounding ‘like a broken record’. With regard to
cognition, treatment decision-making processes may
reflect the spread of anxiety or pessimism from
parent to therapist. The therapeutic team may inad-
vertently collude to avoid strategies that require
parents to set limits on misbehavior (e.g. time-out),
and misinformation regarding risks associated with
such strategies may contribute to this (Dadds &
Tully, 2019). This is analogous to therapists’ avoid-
ance of exposure therapy due to concerns about its
safety in the treatment of anxiety (e.g. Farrell, Kemp,
Blakey, Meyer, & Deacon, 2016).
Thank parents for dissenting
When parents verbalize doubts, objections, and
complaints about treatment, we recommend thank-
ing them for doing so. While it may seem counterin-
tuitive to welcome this, such open communication is
far preferable to obstructive behavior or inaction.
Moreover, we predict that parents who feel encour-
aged to express themselves honestly will be more
receptive to a therapist’s efforts to understand issues
underlying sustain talk and discord.
Name resistance by reframing resistance
Resistance that is implicit and unspoken is at
particular risk of continuing unchecked. Naming it
allows the therapeutic team to examine it openly
together. This naming is a process of reframing, with
a parent’s lack of change described using language
that is neutral, nonjudgmental, and identifies it as
a shared issue (e.g. ‘We’re stuck’). The idea of
resistance as valuable communication may also be
incorporated (e.g. ‘When things are not changing it
can mean we’ve missed something important. . .or
that I haven’t explained something properly’).
Pause active skills-training
By conceptualizing resistance within the therapeutic
team, we assume that it will persist so long as
parent-therapist dynamics remain unchanged. The
temporary suspension of skills-training helps to
interrupt and remediate these dynamics by creating
space to jointly reflect on progress. The therapist
might initiate this by forecasting treatment failure
based on the current rate of progress.
Empower parents to decide the future of treatment
Feelings of powerlessness are common among par-
ents distressed by CPs, often leading them to place
undue responsibility for change on a therapist. The
balance of power may therefore need to be shifted.
The therapist might guide parents to problem-solve
their own solutions to barriers, and motivational
interviewing may further facilitate this (e.g. promot-
ing parent self-efficacy by breaking goals down into
achievable small steps; addressing the pros and cons
of different courses of action). Our approach further
emphasizes the use of ‘reflexive’ questions (see
Tomm, 1987). Various types of reflexive questions
are used in family therapy to encourage individuals
to become observers of their own behavior and
mobilize behavior change through new awareness.
Observer-perspective questions may lead to insights
about challenges associated with specific treatment
components (e.g. ‘What is the difference between the
times when these strategies have worked and when
they haven’t?’). Future-oriented questions can com-
pel parents to face the implications of current
circumstances for the future (e.g. ‘If things continue,
what is going to happen when he is a teenager?’).
Such questions may also be used to introduce
hypothetical possibilities in a process of cocreating
an alternative future together.
© 2021 Association for Child and Adolescent Mental Health
 Parenting interventions for conduct problems 7

This process can serve to generate the ‘news of
difference’ that, according to various models of
family therapy, is a necessary impetus for systemic
change to occur. While paused, the therapist refrains
from proposing any course of action on behalf of the
therapeutic team. Control is handed to the parents,
who determine when, or indeed if, active treatment
will resume. A therapist’s own emotions and
impulses can easily undermine this process when
they cause therapists to avoid the open discussion of
underlying issues or prevent therapists from allow-
ing parents to make their own decisions.
Reset the shared therapeutic agenda
When the complex needs of a family become appar-
ent, or when the early components of treatment fail
to produce change, it is easy for therapists to fall into
the trap of overreaching, adding more and more
components to treatment only to find that nothing is
working. The early core components of treatment
(e.g. positive reinforcement of age-appropriate
behavior; limit-setting for misbehavior) can appear
simplistic to parents and therapists alike. Often
overlooked are the fundamental shifts in family
dynamics with which they are concerned, enabling
parents to connect positively with their child regard-
less of problem behaviors, and to de-escalate conflict
when it arises. Components targeting broader issues
in the family (e.g. parent mental health and marital
discord), may offer limited benefits until these fun-
damental shifts have first occurred. In our experi-
ence, it is often far more beneficial to narrow the
focus of treatment and return to the unfinished
business of these core treatment components before
moving beyond them. In doing so, it is particularly
useful to distinguish between skill deficits versus
performance-deficits (i.e. a parenting skill exists but
is not being applied), and to update treatment goals
accordingly.
broader process of clinical engagement. Although
resistance in this treatment has been associated with
risk factors that overlap with those for CPs them-
selves, it is also understood to disrupt treatment via
effects on therapists and the therapeutic relation-
ship. The potential drivers of this disruption are not
only parent emotion and cognition associated with
the avoidance of discipline confrontations, but ther-
apist ambivalence and avoidance regarding sensitive
issues in the family system and controversial com-
ponents of treatment (e.g. time-out). Accordingly, our
recommendations for practitioners place primary
importance on the use of reflective practice, along
with process strategies based on a systemic approach
to the engagement of both mothers and fathers.
Trials of parenting interventions involving these
specific strategies have demonstrated large treat-
ment effects on child CPs and high ratings of
therapeutic alliance by parents and therapists (e.g.
Dadds, English, et al., 2019; Dadds, Thai, et al.,
2019). Additionally, in a study benchmarking father
involvement in child mental health services across
Australia, the highest rate of session attendance for
fathers was recorded for the clinic in which these
strategies are routinely practiced (Dadds et al.,
2018). Existing research on engagement in parenting
interventions, however, has focused largely on
indices of attendance, and much less on parents’
active participation and enactment of treatment
strategies (Chacko et al., 2016; Haine-Schlagel &
Walsh, 2015; Piotrowska et al., 2019). There is a
need for research to test the strategies and predic-
tions outlined here at the process level, and for
studies in which resistance is operationalized based
on conceptualizations such as that presented.
Acknowledgements
The authors have declared that they have no competing
or potential conflicts of interest.

Conclusions
Recent theory and evidence regarding the delivery of
parenting interventions for CPs have provided a basis
for conceptualizing resistance to change within the
Correspondence
David J. Hawes, School of Psychology, University of
Sydney, Sydney, NSW 2006, Australia; Email:
david.hawes@sydney.edu.au

Key points

 Resistance to change has often been referred to in literature on parenting interventions for child conduct
problems; yet, conceptualizations of the construct have rarely been examined.
 Recent models of clinical engagement in parenting interventions present important implications for
understanding and acting on resistance to change.
 An updated conceptualization of resistance within the dynamics of the therapeutic relationship is proposed.
 Based on the apparent role of therapist responses in the maintenance of resistance, the process of
overcoming resistance is characterized as one of reflective practice.

© 2021 Association for Child and Adolescent Mental Health

8 David J. Hawes and Mark R. Dadds
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Accepted for publication: 13 December 2020